title: Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry.
abstract: BACKGROUND
  A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes.
  
  
  METHODS
  We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers.
  
  
  RESULTS
  Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively.
  
  
  CONCLUSIONS
  Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Torrance Memorial Medical Center, Torrance, CA, United States.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Torrance Memorial Medical Center, Torrance, CA, United States.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Rohan V
authors.initials: RV
authors.lastname: Menon
authors.affiliation: Mid America Heart Institute, Kansas City, MO, United States.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Piedmont Heart Institute, Atlanta, GA, United States.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Piedmont Heart Institute, Atlanta, GA, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Finn
authors.affiliation: Minneapolis VA Healthcare System, Minneapolis, MN, United States; University of Minnesota, Minneapolis, MN, United States.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Medical Center of the Rockies, Loveland, CO, United States.
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: VA San Diego Healthcare System, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States.
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Muhammad Nauman J
authors.initials: MN
authors.lastname: Tarar
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.affiliation: Boston Scientific, Natick, MA, United States.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Chronic total occlusion; Outcomes; Percutaneous coronary intervention; Techniques