title: The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry.
abstract: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.
  
  
  
  The RECHARGE (REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom) registry aims to report achievable results using the hybrid algorithm.
  
  
  
  Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.
  
  
  
  A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. The average Japanese CTO score was 2.0 ± 1.0, and was higher in the failure group (2.6 ± 0.6 vs. 1.9 ± 1.0; p < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm2, respectively.
  
  
  
  High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators.
authors: Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Joren
authors: J
authors: Maeremans
authors: Department of Cardiology, Belfast City Hospital, Belfast, United Kingdom.
authors: Simon
authors: S
authors: Walsh
authors: Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
authors: Paul
authors: P
authors: Knaapen
authors: Department of Cardiology, Forth Valley Royal Hospital, Edinburgh, United Kingdom.
authors: James C
authors: JC
authors: Spratt
authors: Department of Cardiology, Clinique de Marignane, Marignane, France.
authors: Alexandre
authors: A
authors: Avran
authors: Department of Cardiology, Belfast City Hospital, Belfast, United Kingdom.
authors: Colm G
authors: CG
authors: Hanratty
authors: Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France.
authors: Benjamin
authors: B
authors: Faurie
authors: Department of Cardiology, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands; Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors: Pierfrancesco
authors: P
authors: Agostoni
authors: Department of Cardiology, Nouvelles Cliniques Nantaises, Nantes, France.
authors: Erwan
authors: E
authors: Bressollette
authors: Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors: Peter
authors: P
authors: Kayaert
authors: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, United Kingdom.
authors: Alan J
authors: AJ
authors: Bagnall
authors: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, United Kingdom.
authors: Mohaned
authors: M
authors: Egred
authors: Department of Cardiology, Morriston Hospital, Swansea, United Kingdom.
authors: Dave
authors: D
authors: Smith
authors: Department of Cardiology, Morriston Hospital, Swansea, United Kingdom.
authors: Alexander
authors: A
authors: Chase
authors: Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom.
authors: Margaret B
authors: MB
authors: McEntegart
authors: Department of Cardiology, Nottingham University Hospital, Nottingham, United Kingdom.
authors: William H T
authors: WH
authors: Smith
authors: Department of Cardiology, Nottingham University Hospital, Nottingham, United Kingdom.
authors: Alun
authors: A
authors: Harcombe
authors: Department of Cardiology, Essex Cardiothoracic Centre, Basildon Hospital, Essex, United Kingdom.
authors: Paul
authors: P
authors: Kelly
authors: Department of Cardiology, Ninewells Hospital, Dundee, United Kingdom.
authors: John
authors: J
authors: Irving
authors: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
authors: Elliot J
authors: EJ
authors: Smith
authors: Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom.
authors: Julian W
authors: JW
authors: Strange
authors: Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. Electronic address: jo.dens@zol.be.
authors: Joseph
authors: J
authors: Dens
mesh_terms: D000368:Aged; D000465:Algorithms; D054059:Coronary Occlusion / Q000601:surgery*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012042:Registries
keywords: chronic total occlusion; hybrid; percutaneous coronary intervention