Alfredo R. Galassi - The Euro CTO Club: The Registry

EURO CTO CLUBKrakow 2016

8th Experts "Live"

CTO Workshop 2016Sept 30th – Oct 01st, 2016

Alfredo R. Galassi MD, FESC, FACC, FSCAI

Department of Clinical and Experimental MedicineUniversity of Catania, Italy

The Euro CTO Club:

The Registry


Club

Membership

0

20

40

60

80

100

120

140

160

1321

29 33 38 4352 55 61

124

143

0

10

20

30

40

50

60

70

80

90

100

Full Associated Affiliated

48

92

3


Club

Membership

0

500

1000

1500

2000

2500

3000

2008 2009 2010 2011 2012 2013 2014 2015

1303

1724

2189

2634 2603 2660 2615

2404

Online Registry 2008-2015

0%

20%

40%

60%

80%

100%

2008 2009 2010 2011 2012 2013 2014 2015

50

31 28.620.5 18.8 14.6 16.6

5.5

50

69 71.479.5 81.2 85.4 83.4

94.5

Antegrade only Retrograde + Antegrade

Antegrade/Retrograde Operators

0%

20%

40%

60%

80%

100%

2008 2009 2010 2011 2012 2013 2014 2015

90 88.5 89.5 8677

71 72.464.9

10 11.5 10.5 1423

29 27.635.1

Antegrade Retrograde± Antegrade

Antegrade/Retrograde Procedures

0

20

40

60

80

100

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

75 7780 82

85.3 85 85.3 87 85.8 87.1

Angiographic Success

%

0

20

40

60

80

100

2008 2009 2010 2011 2012 2013 2014 2015

85.5 86.5 88.1 87.6 87.8 90.387 89

73.6

64.2

77.1 76.5 77.879.5 82.2 83.3

Antegrade Retrograde

Angiographic Success

%

0

10

20

30

40

50

60

2011

2012

2013

2014

2015

Wires to start

%

Wires to start (Fielder XT Family)

0

10

20

30

40

50

60

2014 2015

Fielder XT R

Fielder XT A

Fielder XT

%

Wires to start (Gaia Family)

0

5

10

15

20

2014 2015

Gaia 3rd

Gaia 2nd

Gaia 1st

%

0

5

10

15

20

25

30

2011

2012

2013

2014

2015

Final wires to cross

%

Final wires to cross(Fielder XT Family)

0

5

10

15

20

25

30

2014 2015

Fielder XT R

Fielder XT A

Fielder XT

%

Final wires to cross(Gaia Family)

0

5

10

15

20

25

2014 2015

Gaia 3rd

Gaia 2nd

Gaia 1st

%

Guiding Catheter Selection in the ERCTO

No trend differences were observed between antegrade

and retrograde approach during years

0

10

20

30

40

50

60

2008 2009 2010 2011 2012 2013 2014 2015

6 Fr 7 Fr 8 Fr

Procedural Details

0

10

20

30

40

50

60

70

80

2008 2009 2010 2011 2012 2013 2014 2015

Contralateral injection Radial approach

0

5

10

15

20

25

30

2009 2010 2011 2012 2013 2014 2015

32

5

7,9 7,3 6,7

12

1 1

6

17,6

22,8 22,7

27,2

2,4 2,1

5

10,311,8 11,1

17,3

Antegrade Retrograde Overall

IVUS

%

0

0,5

1

1,5

2

2,5

3

3,5

2008 2009 2010 2011 2012 2013 2014 2015

Death

Myocardial infarction Vascular complication

Donor vessel dissection

Cardiac tamponade

Coronary perforation

Procedural Complications

Revascularization strategies 2014-2015

2014

2615 CTO PCI attempts

Antegrade only

1892 CTO PCI (72.3%)

Hybrid

410 CTO PCI (15.7%)

Retrograde only

313 CTO PCI (12%)

2015


Antegrade only

1559 CTO PCI (64.9%)

Hybrid

413 CTO PCI (17.4%)

Retrograde only

426 CTO PCI (17.7%)

2014


Antegrade only

1892 CTO PCI (72.3%)

Hybrid

410 CTO PCI (15.7%)

Retrograde only

313 CTO PCI (12%)

Unsuccessful

242 CTO PCI (9.2%)Successful

1650 CTO PCI (90.8%)

1222(74.1%)

185(11.2%)

169(10.2%)

74(4.5%)

Single wire

Parallel wire

Step up/Step down

ADR

2015


Antegrade only

1559 CTO PCI (64.9%)

Hybrid

413 CTO PCI (17.4%)

Retrograde only

426 CTO PCI (17.7%)

Unsuccessful

172 CTO PCI (11%)

Successful

1387 CTO PCI (89%)

906(65.3%)

185(13.3%)

208(15%)

88(6.4%)

Single wire

Parallel wire

Step up/Step down

ADR

2014


Antegrade only

1892 CTO PCI (72.3%)

Hybrid

410 CTO PCI (15.7%)

Retrograde only

313 CTO PCI (12%)

Unsuccessful

26 CTO PCI (8.3%)Successful

287 CTO PCI (91.7%)

116(40.4%)

23(8%)3

(1.1%)

145(50.5%)

Wire Crossing

Touching wire

CART

Reverse CART

2015


Antegrade only

1559 CTO PCI (64.9%)

Hybrid

413 CTO PCI (17.4%)

Retrograde only

426 CTO PCI (17.7%)

Unsuccessful

30 CTO PCI (7%)Successful

396 CTO PCI (93%)

125(31.5%)

47(11.8%)

3(0.7%)

221(55.8%)

Wire Crossing

Touching wire

CART

Reverse CART

2014


Antegrade only

1892 CTO PCI (72.3%)

Hybrid

410 CTO PCI (15.7%)

Retrograde only

313 CTO PCI (12%)

37(40.2%)

22(23.9%)

15(16.3%)

18(19.6%)

Single wire

Parallel wire

Step up/Step down

ADR

Unsuccessful

103 CTO PCI (25.1%)Successful Antegrade

92 CTO PCI (22.4%)

2015


Antegrade only

1559 CTO PCI (64.9%)

Hybrid

413 CTO PCI (17.4%)

Retrograde only

426 CTO PCI (17.7%)

33(30%)

26(23.6%)

21(19.1%)

30(27.3%)

Single wire

Parallele wire

Step up/Step down

ADR

Unsuccessful


110 CTO PCI (26.6%)

Antegrade only

1892 CTO PCI (72.3%)

Hybrid

410 CTO PCI (15.7%)

Retrograde only

313 CTO PCI (12%)

Unsuccessful


92 CTO PCI (22.4%)

2014


Successful Retrograde

215 CTO PCI (52.5%)

78(36.3%)

26(12.1%)2

(0.9%)

109(50.7%)

Wire Crossing

Touching wire

CART

Reverse CART

Antegrade only

1559 CTO PCI (64.9%)

Hybrid

413 CTO PCI (17.4%)

Retrograde only

426 CTO PCI (17.7%)

Unsuccessful


110 CTO PCI (26.6%)

2015


Successful Retrograde

396 CTO PCI (89%)

48(24.9%)

19(9.8%)

5(2.6%)

121(62.7%)

Wire Crossing

Touching wire

CART

Reverse CART

J-CTO score

283(11.8%)

477(19.8%)

652 (27.1%)

599 (24.9%)

321(13.4%)

71(3%)

0 1 2 3 4 5

121(4.6%)

529(20.2%)

946 (36.2%)

718(27.5%)

254(9.7%)

47(1.8%)

0 1 2 3 4 5

2014 2015

Revascularization strategies

according to J-CTO score 2014

93.486.4

73.564.9

52

36.2

2.57.5

14.621.5

28.7

29.8

4.16.1

11.9 13.619.3

34

0

20

40

60

80

100

0 1 2 3 4 5

Antegrade only Hybrid Retrograde only

%

P<0.05

89.282.6

65.854.1

43.3

26.8

5.18.6

17

23.7

28

29.6

5.7 8.817.2 22.2

28.7

43.6

0

20

40

60

80

100

0 1 2 3 4 5

Antegrade only Hybrid Retrograde only


according to J-CTO score 2015

%


according to J-CTO score

2014

95.9 92.3 88.882

7670.2

4.1 7.7 11.218

2429.8

0

20

40

60

80

100

0 1 2 3 4 5

Conventional wire escalation Dissection re-entry

P<0.05

%


according to J-CTO score

2015

95.7 92.5

79.371.2

65.753.5

4.3 7.5

20.728.8

34.346.5

0

20

40

60

80

100

0 1 2 3 4 5

Conventional wire escalation Dissection re-entry

P<0.05

%

94.2 94.9

83.7 85.5

74.470.2

79.9

93.990.5

86.6

81.6

73.2

0

20

40

60

80

100

0 1 2 3 4 5

2014 2015

Success according to J-CTO score

2014 p<0.05

2015 p=NS%

Conclusions from the Euro CTO club

Number of CTO recanalization increased from 2008 till 2015 from

~1000 to ~2.500 per/year

Overall success stable around ~85-90% in the last 5 years

Retrograde procedures increased significantly from 2011 onwards

(up to ~35%)

Severe complications <1.5-2.0%

Predictive scores could be applied to select the appropriate

candidates for PCI among CTO patients and the appropriate

strategy to use

The higher the J-CTO score, the greater the need for hybrid and

retrograde approaches, and the greater the use of dissection re-

entry techniques

Thank You

For Your Attention

www.alfredogalassi.com

Alfredo R. Galassi - The Euro CTO Club: The Registry

Health & Medicine

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