title: Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry.
abstract: Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention.
  
  
  
  We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade-only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time.
  
  
  
  Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.affiliation: Henry Ford Hospital, Detroit, MI.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, CA.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, CA.
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Danek
authors.affiliation: Medical Center of the Rockies, Loveland, CO.
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.affiliation: Mid America Heart Institute, Kansas City, MO.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Columbia University, New York, NY.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Columbia University, New York, NY.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Columbia University, New York, NY.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.affiliation: Columbia University, New York, NY.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.affiliation: Columbia University, New York, NY.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Piedmont Heart Institute, Atlanta, GA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Piedmont Heart Institute, Atlanta, GA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Torrance Memorial Medical Center, Torrance, CA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Wyman
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Aya
authors.initials: A
authors.lastname: Alame
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Phuong-Khanh J
authors.initials: PK
authors.lastname: Nguyen-Trong
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Erica
authors.initials: E
authors.lastname: Resendes
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Pratik
authors.initials: P
authors.lastname: Kalsaria
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary.
authors.forename: Imre
authors.initials: I
authors.lastname: Ungi
authors.affiliation: Boston Scientific, Natick, MA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D041623:Tomography, Optical Coherence / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: chronic total occlusion; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention