title: Prevalence and treatment of "balloon-uncrossable" coronary chronic total occlusions.
abstract: BACKGROUND
  The frequency and outcomes of "balloon-uncrossable" coronary chronic total occlusions (CTOs) have received limited study.
  
  
  METHODS
  We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs.
  
  
  RESULTS
  Mean age was 63.7 ± 8.3 years and 98.9% of the patients were men. Twenty-four patients (6.4%, 95% confidence intervals 4.2% to 9.4%) were found to have a balloon-uncrossable CTO. Compared to the other CTO PCI patients, those with balloon-uncrossable CTOs had similar clinical and angiographic characteristics. Successful crossing of the balloon-uncrossable CTO was achieved in 22 of 24 patients (91.7%) using a variety of techniques, such as successive balloon inflations (43.5%), microcatheter advancement (21.7%), laser (8.7%), techniques that increase guide catheter support (13.0%), and subintimal lesion crossing (13.0%). Patients with balloon-uncrossable CTOs had longer procedure time (184.5 ± 77.9 vs 134.0 ± 69.0 min, P<.01), fluoroscopy time (55.2 ± 24.9 vs 37.9 ± 20.8 min, P<.01), and received high contrast volume (404.4 ± 137.9 vs 351.7 ± 138.5 mL, P=.08), but had similar incidence of major complications (8.3% vs 3.2%, P=.25) as compared with patients who did not have balloon-uncrossable CTOs.
  
  
  CONCLUSIONS
  Balloon-uncrossable CTOs are encountered in 6.4% of contemporary CTO PCIs and can be successfully treated in most patients using a variety of techniques.
authors: VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Division of Cardiology (111A), 4500 S. Lancaster Rd, Dallas, TX 75216 USA. esbrilakis@gmail.com.
authors: Siddharth M
authors: SM
authors: Patel
authors: Nagendra R
authors: NR
authors: Pokala
authors: Rohan V
authors: RV
authors: Menon
authors: Anna P
authors: AP
authors: Kotsia
authors: Vijay
authors: V
authors: Raja
authors: George
authors: G
authors: Christopoulos
authors: Tesfaldet T
authors: TT
authors: Michael
authors: Bavana V
authors: BV
authors: Rangan
authors: Daniel
authors: D
authors: Sherbet
authors: Vishal G
authors: VG
authors: Patel
authors: Shuaib A
authors: SA
authors: Abdullah
authors: Jeffrey
authors: J
authors: Hastings
authors: Jerrold M
authors: JM
authors: Grodin
authors: Subhash
authors: S
authors: Banerjee
authors: Emmanouil S
authors: ES
authors: Brilakis
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000706:statistics & numerical data; D057785:Catheters; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors