title: The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions: insights from a contemporary multicenter US registry and comparison with prior studies.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is challenging and has been associated with low success rates. However, recent advancements in equipment and the flexibility to switch between multiple technical approaches during the same procedure ("hybrid" percutaneous algorithm) have dramatically increased the success of CTO-PCI. We sought to compare the contemporary procedural outcomes of hybrid CTO-PCI with previously published CTO-PCI studies.
  
  
  METHODS
  The procedural outcomes of 497 consecutive CTO-PCIs performed between January 2012 and August 2013 at five high-volume centers in the United States were compared with the pooled success and complication rates reported in 39 prior CTO-PCI series that included ≥100 patients and were published after 2000.
  
  
  RESULTS
  The baseline clinical and angiographic characteristics of the study patients were comparable to those of previous studies. Technical and procedural success was achieved in 455 cases (91.5%) and 451 cases (90.7%), respectively, and were significantly higher than the pooled technical and procedural success rates from prior studies (76.5%, P<.001 and 75.2%, P<.001, respectively). Major procedural complications occurred in 9/497 patients (1.8%) overall and included death (2 patients), acute myocardial infarction (5 patients), repeat target vessel PCI (1 patient), and tamponade requiring pericardiocentesis (2 patients). The incidence of major complications was similar to that of prior studies (pooled rate 2.0%; P=.72).
  
  
  CONCLUSIONS
  Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to prior studies, supporting its expanded use for treating these challenging lesions.
authors.affiliation: Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216 USA. esbrilakis@gmail.com.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.forename: Rohan V
authors.initials: RV
authors.lastname: Menon
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.forename: William
authors.initials: W
authors.lastname: Lombardi
authors.forename: Aaron
authors.initials: A
authors.lastname: Grantham
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
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
authors.initials: D
authors.lastname: Kandzari
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; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology