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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Plaque modification in calcified chronic total occlusions: the PLACCTON study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:213-222. [PMID: 34301507 DOI: 10.1016/j.rec.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. METHODS Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. RESULTS Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). CONCLUSIONS Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits.
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Affiliation(s)
- José R Delgado-Arana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José R Rumoroso
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Gema Miñana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Mohsen Mohandes
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Alfonso Jurado-Román
- Departamento de Cardiología, Hospital La Paz, Madrid, Spain; Departamento de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Javier Lacunza
- Departamento de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Fernando Rivero
- Departamento de Cardiología, Hospital de La Princesa, Madrid, Spain
| | | | - Juan Rondán
- Departamento de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | | | - Sandra Santos-Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Asier Subinas
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Víctor Arévalos
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandro Diego Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Sergio Rojas
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier Goicolea
- Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Mario Sádaba
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Itziar Gómez-Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manel Sabaté
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jean Carlos Núñez García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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