Abstract 4364380: Outcomes of Coronary Chronic Total Occlusion Modification procedures

Background: Chronic total occlusion (CTO) modification procedures are defined as intentional balloon dilatation (diameter ≥2.0 mm) of the entire CTO, including the proximal and distal caps and the CTO body. The outcomes of CTO modification procedures have received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and outcomes of 2,829 patients, with a total of 2,869 CTOs who underwent a CTO percutaneous coronary intervention (PCI) after a previous failure attempt from the PROGRESS-CTO registry. Results: Of these 2,869 CTO lesions, 600 (20.9%) had undergone modification procedures during the index procedure. Patients who underwent CTO modification were older with higher prevalence of hypertension (92.0% vs 87.6, p=0.005) and dyslipidemia (94.0% vs 83.4%, p<0.001), lower rate of interventional collaterals (49.2 vs 57.5, p<001), higher angiographic complexity, including more moderate/severe calcification (59.4% vs 48.5%, p<0.001) and moderate/severe proximal tortuosity (43.6% vs 30.4%, p<0.001). The most common CTO target vessel in both groups was the Right Coronary Artery (RCA). CTO modification lesions were longer (38.35 vs 30.58 mm, p<0.001) and had higher prevalence of blunt/no stump (63.9% vs 54.5%, p<0.001) and in-stent restenosis (24.6% vs 20.2%, p=0.031), but lower prevalence of side branch at the proximal cap (51.9% vs 61.2%, p<0.001). Lesions that underwent modification had higher J-CTO scores. There was no statistically significant difference in technical (84.1% vs 85.4%, p=0.478) and procedural success (82.7% vs 84.3%, p=0.403) or MACE (1.7% vs 1.8%, p=1.000), between patients who had undergone modification procedures and those who had not. Conclusions: Despite higher lesion complexity CTOs that underwent modification after an unsuccessful initial attempt were recanalized at equally high success and equally low complication rates during the repeat attempt.