title: The efficacy of "hybrid" percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis: insights from a US multicenter registry.
abstract: OBJECTIVE
  To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR).
  
  
  BACKGROUND
  PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs.
  
  
  METHODS
  We examined 521 consecutive patients who underwent CTO PCI at five high-volume PCI centers in the United States using the "hybrid" approach. Clinical, angiographic, and procedural outcomes were compared between CTOs due to ISR and de novo CTOs.
  
  
  RESULTS
  The target CTO was due to ISR in 57 of 521 patients (10.9%). Compared to patients with de novo CTOs, those with CTO due to ISR had higher frequency of diabetes (56.1% vs. 39.6%, P = 0.02) and less calcification (5.3% vs. 16.2%, P <0.001), but longer occlusion length [38 (29-55) vs. 30 (20-51), P = 0.04]. Technical success in the ISR and de novo group was 89.4% and 92.5% (P = 0.43), respectively; procedural success was 86.0% and 90.3% (P = 0.31), respectively; and the incidence of major adverse cardiac events was 3.5% and 2.2% (P = 0.63), respectively.
  
  
  CONCLUSIONS
  Use of the "hybrid" approach to CTO PCI was associated with similarly high procedural success and similarly low major complication rates in patients with de novo and ISR CTOs.
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Anna P
authors.initials: AP
authors.lastname: Kotsia
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.forename: Anna
authors.initials: A
authors.lastname: Kalynych
authors.forename: Harold
authors.initials: H
authors.lastname: Carlson
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D000465:Algorithms; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019091:Critical Pathways; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D012042:Registries; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014481:United States
keywords: chronic total occlusion; in-stent restenosis; percutaneous coronary intervention