title: Contrast Utilization During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry.
abstract: BACKGROUND
  Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy.
  
  
  METHODS
  We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers.
  
  
  RESULTS
  Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P=.01), smoking (P=.01), prior coronary artery bypass graft surgery (P=.04), moderate or severe calcification (P=.01), moderate or severe tortuosity (P=.04), proximal cap ambiguity (P=.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P=.01), occlusion length (P<.001), higher J-CTO score (P=.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P=.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P=.01) and in-stent restenosis (P=.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P=.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P=.01), 8 Fr guide catheters (P=.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P=.02), larger target vessel diameter (P=.03), and presence of "interventional" collaterals (P<.001) were associated with lower contrast utilization.
  
  
  CONCLUSIONS
  Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.forename: William
authors.initials: W
authors.lastname: Lombardi
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.forename: David A
authors.initials: DA
authors.lastname: Kandzari
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.forename: Matthew
authors.initials: M
authors.lastname: Finn
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Dallas VA Medical Center (111A); 4500 South Lancaster Road, Dallas, TX 75216 USA. esbrilakis@ gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery; D017723:Drug Utilization Review / Q000379:methods / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D003287:Contrast Media