Scopus
Modification Procedures for Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
Catheterization and Cardiovascular Interventions · Aralık 2025
Makale Bilgileri
DergiCatheterization and Cardiovascular Interventions
Yayın TarihiAralık 2025
Cilt / Sayfa106 · 3628-3639
Scopus ID2-s2.0-105024020673
Özet
Background: CTO-ARC (Chronic Total Occlusion Academic Research Consortium) defines CTO modification procedures (previously called investment procedures) as intentional balloon dilatation (diameter ≥ 2.0 mm) of the entire CTO, including the proximal and distal caps and the CTO body. Aims: The aim of this study is to compare the outcomes of repeat CTO PCI between patients who underwent lesion modification during the initial failed procedure and those who did not. Methods: We analyzed the association of CTO modification with the baseline clinical and angiographic characteristics and outcomes of 2829 patients, with a total of 2869 CTOs who underwent CTO percutaneous coronary intervention (PCI) after a previously failed attempt. Results: CTO modification was performed in 600 of 2869 CTOs (20.9%) that underwent a repeat PCI attempt. CTOs that underwent modification had a higher prevalence of blunt/no stump (63.9% vs. 54.5%, p < 0.001), moderate/severe calcification (59.4% vs. 48.5%, p < 0.001), and moderate/severe proximal tortuosity (43.6% vs. 30.4%, p < 0.001). They also had longer length (38 vs. 31 mm, p < 0.001) and higher J-CTO (3.69 vs. 3.21, p < 0.001) score. There was no statistically significant difference in technical (84.1% vs. 85.4%, p = 0.478) or procedural (82.7% vs. 84.2%, p = 0.403) success or major adverse cardiac events (MACE, 1.7% vs. 1.8%, p = 1.0) between the modification and no modification groups. Similarly, among patients who underwent CTO modification, there were no significant differences in outcomes between early (< 60 days) and late (≥ 60 days) reattempts after the initial failure. Technical success was significantly higher after subintimal tracking and re-entry (STAR) than subintimal plaque modification (SPM) (82.5% vs. 60.0%, p = 0.028). Conclusions: CTO modification procedures were performed in approximately one of five CTO PCIs during the initial failed procedure. During reattempt CTO PCI, despite higher lesion complexity, CTO modification was associated with similar technical and procedural success and MACE compared to patients undergoing reattempt CTO PCI without prior CTO modification. Among modification techniques, STAR was associated with higher technical and procedural success than SPM.
Yazarlar (99)
1
Eleni Kladou
ORCID: 0009-0002-9067-4692
2
Dimitrios Strepkos
3
Michaella Alexandrou
4
Deniz Mutlu
5
Pedro E.P. Carvalho
6
Jaskanwal Deep Singh Sara
7
Ozgur Selim Ser
8
Khaldoon Alaswad
9
Mir Babar Basir
10
Dmitrii Khelimskii
ORCID: 0000-0001-5419-913X
11
Farouc A. Jaffer
12
Nidal Abi-Rafeh
13
Raj H. Chandwaney
14
Cihan Cevik
15
Yousif Ahmad
16
Olga C. Mastrodemos
17
Bavana V. Rangan
18
Sandeep Jalli
ORCID: 0009-0008-3915-7853
19
Konstantinos Voudris
20
Yader Sandoval
21
M. Nicholas Burke
22
Emmanouil S. Brilakis
23
Shuaib Abdullah
24
Sakir Arslan
25
Khaldoon Alaswad
26
Karim M. Al-Azizi
ORCID: 0000-0003-0195-4984
27
Ziad A. Ali
28
Bulent Behlul Altunkeser
29
Waqar Ahmed
30
Ibtihal Al Amri
31
Yousif Ahmad
32
Nazif Aygül
33
Lorenzo Azzalini
34
Subhash Banerjee
35
Emmanouil S. Brilakis
ORCID: 0000-0001-9416-9701
36
Keith H. Benzuly
37
Stewart Benton
38
Mir B. Basir
39
James W. Choi
40
Jaidip Chakravartti
41
Cihan Cevik
42
Larry Van Thomas Crisco
43
Raj H. Chandwaney
44
Rhian Davies
45
Altug Cincin
46
Ahmed M. ElGuindy
47
Anthony H. Doing
48
Ali El Sayed
49
Philip Dattilo
50
Jarrod Frizzell
51
Basem Elbarouni
52
Omer Goktekin
53
James D. Flaherty
54
J. Aaron Grantham
55
Farshad Forouzandeh
56
David Garcia-Labbe
57
Santiago Garcia
58
Matt Grove
59
Sevket Gorgulu
60
Wissam Jaber
61
Elias V. Haddad
62
Fadi Abou Jaoudeh
63
Farouc A. Jaffer
64
J. Wouter Jukema
65
Brian K. Jefferson
66
Yasser Jamil
67
Kathleen E. Kearney
68
Nihat Kalay
69
David E. Kandzari
70
Kadriye Orta Kilickesmez
71
Ismail Dogu Kilic
72
Dmitrii Khelimskii
73
Jimmy Kerrigan
74
Alex R. Kirby
75
Dimitrios Karmpaliotis
76
Athanasios Kolyviras
77
Jaikirshan J. Khatri
78
Michael J. Kourany
79
Georges Khoueiry
80
Oleg Krestyaninov
81
Ajay J. Kirtane
82
Zenon S. Kyriakides
83
Cuneyt Kocas
84
Arun Kalyanasundaram
85
Nicholas Lembo
86
Faisal Latif
87
William L. Lombardi
88
Anton Lishmanov
89
Michael P. Love
90
Bilal A. Malik
91
Ehtisham Mahmud
92
Owen Mogabgab
93
Henry Meltser
94
Belal Al Khiami
95
Jeffrey W. Moses
96
Jose M. Montero Cabezas
97
Charles Orr
98
Husam Noor
99
Manish A. Parikh
Anahtar Kelimeler
chronic total occlusion
modification procedure
percutaneous coronary intervention
Kurumlar
Acibadem Kocaeli Hospital
Izmit Turkey
Aswan Heart Centre
Cairo Egypt
Biruni Üniversitesi
Istanbul Turkey
Carolina East Medical Center
New Bern United States
Centennial Medical Center
Nashville United States
Cleveland Clinic Foundation
Cleveland United States
Columbia University
New York United States
Emory Healthcare
Atlanta United States
E.N. Meshalkin National Medical Research Center
Novosibirsk Russian Federation
Erciyes Üniversitesi
Kayseri Turkey
Hellenic Red Cross Hospital
Athens Greece
Henry Dunant Hospital
Athens Greece
Henry Ford Hospital
Detroit United States
Henry Ford Hospitals
Detroit United States
Hôpital St-Boniface
Winnipeg Canada
Institut Universitaire de Cardiologie et de pneumologie de Québec - Université Laval
Quebec Canada
King Fahd Armed Forces Hospital
Jeddah Saudi Arabia
Leids Universitair Medisch Centrum
Leiden Netherlands
Maimonides Medical Center
New York United States
MaineHealth
Portland United States
Marmara Üniversitesi Tip Fakültesi
Istanbul Turkey
Massachusetts General Hospital
Boston United States
Memorial Bahcelievler Hospital
Istanbul Turkey
Memorial Hospital Jacksonville
Jacksonville United States
Mid America Heart Institute - Kansas City
Kansas City United States
Minneapolis Heart Institute
Minneapolis United States
Morristown Medical Center
Morristown United States
North Oaks Health System
Hammond United States
Northwestern Memorial Hospital
Chicago United States
Oklahoma City Department of Veterans Affairs Medical Center
Oklahoma City United States
Oklahoma Heart Institute
Tulsa United States
Pammukale University
Denizli Turkey
Piedmont Heart Institute
Atlanta United States
Poudre Valley Health System, Medical Center of the Rockies
Loveland United States
Promed Hospital
Chennai India
Saint George Hospital University Medical Center
Beirut Lebanon
Saint Thomas Heart Hospital
Nashville United States
Selçuk Üniversitesi
Selçuklu Turkey
Sisli Hamidiye Etfal Education and Research Hospital
Istanbul Turkey
St. Francis Hospital & Heart Center
Roslyn United States
St. Vincent Hospital - Indianapolis
Indianapolis United States
Texas Health Presbyterian Dallas
Dallas United States
The Heart Hospital Baylor Plano
Plano United States
Tulane University School of Medicine
New Orleans United States
UCHealth
Aurora United States
University Hospitals Case Medical Center
Cleveland United States
University of California, San Diego
La Jolla United States
University of California, San Francisco
San Francisco United States
University of Health Sciences
Istanbul Turkey
University of Washington
Seattle United States
UW Medical Center – Montlake
Seattle United States
VA North Texas Health Care System
Dallas United States
WNY
Buffalo United States
Yale-New Haven Hospital
New Haven United States
York Hospital, Pennsylvania
York United States
Zahra University Hospital
Beirut Lebanon