Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention.
Judit Karacsonyi, Spyridon Kostantinis, Bahadir Simsek, Athanasios Rempakos, Salman S Allana, Khaldoon Alaswad, Oleg Krestyaninov, Jaikirshan Khatri, Paul Poommipanit, Farouc A Jaffer, James Choi, Mitul Patel, Sevket Gorgulu, Michalis Koutouzis, Ioannis Tsiafoutis, Abdul M Sheikh, Ahmed ElGuindy, Basem Elbarouni, Taral Patel, Brian Jefferson, Jason R Wollmuth, Robert Yeh, Dimitrios Karmpaliotis, Ajay J Kirtane, Margaret B McEntegart, Amirali Masoumi, Rhian Davies, Bavana V Rangan, Olga C Mastrodemos, Darshan Doshi, Yader Sandoval, Mir B Basir, Michael S Megaly, Imre Ungi, Nidal Abi Rafeh, Omer Goktekin, Emmanouil S Brilakis
Author Information
Judit Karacsonyi: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA. ORCID
Spyridon Kostantinis: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA. ORCID
Bahadir Simsek: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Athanasios Rempakos: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Salman S Allana: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Khaldoon Alaswad: Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA.
Oleg Krestyaninov: Meshalkin Novosibirsk Research Institute, Novosibirsk 630055, Russia. ORCID
Jaikirshan Khatri: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
Paul Poommipanit: Cardiology, Case Western Reserve University, University Hospitals, Cleveland, OH 44610, USA. ORCID
Farouc A Jaffer: Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA.
James Choi: Department of Cardiology, Baylor Heart and Vascular Hospital, Dallas, TX 75226, USA.
Mitul Patel: Cardiovascular Institute, University of California San Diego, VA San Diego Healthcare System, La Jolla, CA 92037, USA.
Sevket Gorgulu: Department of Cardiology, Biruni University School of Medicine, Istanbul 34295, Turkey. ORCID
Michalis Koutouzis: First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece.
Ioannis Tsiafoutis: First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece.
Abdul M Sheikh: Interventional Cardiology Department, Wellstar Health System, Marietta, GA 30141, USA.
Ahmed ElGuindy: Aswan Heart Centre, Department of Cardiology, Magdi Yacoub Foundation, Aswan 4271185, Egypt.
Basem Elbarouni: Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, MB R2H 2A6, Canada.
Taral Patel: Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA.
Brian Jefferson: Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA.
Jason R Wollmuth: Interventional Cardiology, Providence Heart institute, Portland, OR 97213, USA.
Robert Yeh: Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Dimitrios Karmpaliotis: Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA.
Ajay J Kirtane: Division of Cardiology, Columbia University, New York, NY 10032, USA.
Margaret B McEntegart: Division of Cardiology, Columbia University, New York, NY 10032, USA.
Amirali Masoumi: Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA.
Rhian Davies: Interventional Cardiology, WellSpan York Hospital, York, PA 17403, USA. ORCID
Bavana V Rangan: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Olga C Mastrodemos: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Darshan Doshi: Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA.
Yader Sandoval: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Mir B Basir: Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA.
Michael S Megaly: Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA.
Imre Ungi: Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, 6725 Szeged, Hungary.
Nidal Abi Rafeh: Cardiology, North Oaks Health System, Hammond, LA 70403, USA.
Omer Goktekin: Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul 34676, Turkey.
Emmanouil S Brilakis: Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, < 0.001) and diabetes mellitus (50% vs. 42%, < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. < 0.001), moderate/severe calcification (68% vs. 40%, < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, < 0.001) and procedural (88% vs. 96%, < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, < 0.001). Several techniques were required for balloon uncrossable lesions. In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
