Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic Total Occlusions

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-06-09 DOI:10.1016/j.jcin.2025.04.035

Giuseppe Vadalà MD , Kambis Mashayekhi MD, PhD , Michael Behnes MD, PhD , Mohamed Ayoub MD , Sevket Gorgulu MD, PhD , Gerald S. Werner MD, PhD , Nihat Kalay MD , Alexander Avran MD , Omer Goktekin MD , Roberto Garbo MD , Wojcik Jaroslaw MD, PhD , Myron Zaczkiewicz MD , Juergen Arnez MD , Stylianos Pyxaras MD, PhD , Evald Høj Christiansen MD, PhD , Juan Luis Gutiérrez-Chico MD, PhD , Laura Maniscalco PhD , Cristina Madaudo MD , Nicolaus Boudou MD , Sinisa Stojkovic MD, PhD , Alfredo R. Galassi MD

{"title":"Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic Total Occlusions","authors":"Giuseppe Vadalà MD , Kambis Mashayekhi MD, PhD , Michael Behnes MD, PhD , Mohamed Ayoub MD , Sevket Gorgulu MD, PhD , Gerald S. Werner MD, PhD , Nihat Kalay MD , Alexander Avran MD , Omer Goktekin MD , Roberto Garbo MD , Wojcik Jaroslaw MD, PhD , Myron Zaczkiewicz MD , Juergen Arnez MD , Stylianos Pyxaras MD, PhD , Evald Høj Christiansen MD, PhD , Juan Luis Gutiérrez-Chico MD, PhD , Laura Maniscalco PhD , Cristina Madaudo MD , Nicolaus Boudou MD , Sinisa Stojkovic MD, PhD , Alfredo R. Galassi MD","doi":"10.1016/j.jcin.2025.04.035","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Significant calcifications within a coronary chronic total occlusion (CTO) increase procedural complexity and the risk for complications. Expert consensus documents recommend the use of advanced calcific plaque modification devices (ACPMDs) for calcified CTO percutaneous coronary intervention (PCI), whereas data on their procedural impact are limited.</div></div><div><h3>Objectives</h3><div>The aim of this study was to describe trends, settings, and outcomes of PCI of severely calcified CTO performed with and without ACPMDs.</div></div><div><h3>Methods</h3><div>Data from 15,329 CTO PCIs enrolled in the ERCTO (European Registry of Chronic Total Occlusion) between 2021 and 2023 were analyzed. On the basis of the presence of severe calcifications within the CTO, the study population was divided into 2 groups: nonsevere (n = 12,289) and severe (n = 3,040) calcium. Then, the severe group was divided into non-ACPMD (n = 2,253) and ACPMD (n = 787), according to the use of ACPMDs.</div></div><div><h3>Results</h3><div>Compared with the non-ACPMD group, the ACPMD group had higher rates of antegrade wiring (77.9% vs 49.2%; <em>P</em> < 0.001) and technical success (97.6% vs 79.1%; <em>P</em> = 0.001) and lower rates of periprocedural and in-hospital major adverse cardiac and cerebrovascular events (MACCE) (1.8% vs 3.5%; <em>P</em> = 0.001). A severe amount of calcium was independently associated with technical failure (OR: 3.13; 95% CI: 2.43-4.09; <em>P</em> < 0.001) but not with MACCE (OR: 0.88; 95% CI: 0.58-1.35; <em>P</em> = 0.15). Furthermore, extraplaque crossing was independently associated with MACCE (antegrade dissection and re-entry without retrograde contribution: OR: 3.12; 95% CI: 1.79-4.20; <em>P</em> < 0.001; antegrade dissection and re-entry with retrograde contribution: OR: 3.12; 95% CI: 1.67-4.11; <em>P</em> = 0.049; retrograde dissection and re-entry: OR: 1.90; 95% CI: 1.25-2.86; <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>Applying ACPMDs in severely calcified CTO to PCI was associated with higher technical success and lower MACCE rates. The presence of severe coronary calcification on coronary angiography was a marker of clinical and procedural complexity and was associated with technical failure but not with MACCE.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 11","pages":"Pages 1376-1390"},"PeriodicalIF":11.4000,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular interventions","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936879825013007","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Significant calcifications within a coronary chronic total occlusion (CTO) increase procedural complexity and the risk for complications. Expert consensus documents recommend the use of advanced calcific plaque modification devices (ACPMDs) for calcified CTO percutaneous coronary intervention (PCI), whereas data on their procedural impact are limited.

Objectives

The aim of this study was to describe trends, settings, and outcomes of PCI of severely calcified CTO performed with and without ACPMDs.

Methods

Data from 15,329 CTO PCIs enrolled in the ERCTO (European Registry of Chronic Total Occlusion) between 2021 and 2023 were analyzed. On the basis of the presence of severe calcifications within the CTO, the study population was divided into 2 groups: nonsevere (n = 12,289) and severe (n = 3,040) calcium. Then, the severe group was divided into non-ACPMD (n = 2,253) and ACPMD (n = 787), according to the use of ACPMDs.

Results

Compared with the non-ACPMD group, the ACPMD group had higher rates of antegrade wiring (77.9% vs 49.2%; P < 0.001) and technical success (97.6% vs 79.1%; P = 0.001) and lower rates of periprocedural and in-hospital major adverse cardiac and cerebrovascular events (MACCE) (1.8% vs 3.5%; P = 0.001). A severe amount of calcium was independently associated with technical failure (OR: 3.13; 95% CI: 2.43-4.09; P < 0.001) but not with MACCE (OR: 0.88; 95% CI: 0.58-1.35; P = 0.15). Furthermore, extraplaque crossing was independently associated with MACCE (antegrade dissection and re-entry without retrograde contribution: OR: 3.12; 95% CI: 1.79-4.20; P < 0.001; antegrade dissection and re-entry with retrograde contribution: OR: 3.12; 95% CI: 1.67-4.11; P = 0.049; retrograde dissection and re-entry: OR: 1.90; 95% CI: 1.25-2.86; P = 0.002).

Conclusions

Applying ACPMDs in severely calcified CTO to PCI was associated with higher technical success and lower MACCE rates. The presence of severe coronary calcification on coronary angiography was a marker of clinical and procedural complexity and was associated with technical failure but not with MACCE.

查看原文本刊更多论文

先进的钙化斑块改良装置对经皮慢性全闭塞血运重建术的程序影响

背景：冠状动脉慢性全闭塞（CTO）的明显钙化增加了手术的复杂性和并发症的风险。专家共识文件建议使用先进的钙化斑块修饰装置（ACPMDs）进行钙化的CTO经皮冠状动脉介入治疗（PCI），然而关于其程序影响的数据有限。本研究的目的是描述在有和没有acpmd的情况下对严重钙化CTO进行PCI的趋势、设置和结果。方法分析2021年至2023年期间在ERCTO（欧洲慢性全闭塞注册中心）注册的15,329名CTO pci的数据。根据CTO内存在严重钙化的情况，将研究人群分为2组：非重度钙化（n = 12,289）和重度钙化（n = 3,040）。根据ACPMD的使用情况，将重症组分为非ACPMD组（2253例）和ACPMD组（787例）。结果与非ACPMD组相比，ACPMD组有更高的顺行布线率(77.9% vs 49.2%；P & lt;0.001)和技术成功(97.6% vs 79.1%；P = 0.001)，围手术期和院内主要心脑血管不良事件（MACCE）发生率较低(1.8% vs 3.5%；P = 0.001)。严重的钙含量与技术故障独立相关(OR: 3.13；95% ci: 2.43-4.09；P & lt;0.001)，但与MACCE无关(OR: 0.88；95% ci: 0.58-1.35；P = 0.15)。此外，斑块外交叉与MACCE（无逆行贡献的顺行剥离和再入）独立相关：OR: 3.12；95% ci: 1.79-4.20；P & lt;0.001;顺行解剖和逆行再入：OR: 3.12；95% ci: 1.67-4.11；P = 0.049；逆行剥离和再入：OR: 1.90；95% ci: 1.25-2.86；P = 0.002)。结论在严重钙化CTO患者行PCI时应用ACPMDs具有较高的技术成功率和较低的MACCE率。冠状动脉造影显示严重的冠状动脉钙化是临床和手术复杂性的标志，与技术失败有关，但与MACCE无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.