Trends of Drug Coated Balloon Use in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Abstract

BACKGROUND: There is limited information on the use of drug-coated balloons (DCBs) in chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI).METHODS: We evaluated the frequency of DCB use in an international registry (PROGRESS-CTO [Prospective Global Registry for the Study of Chronic Total Occlusion Intervention]).RESULTS: Among 7,893 patients, DCBs were used in 200 cases (2.5%; paclitaxel coated in 91.8%, sirolimus coated in 8.2%) with increasing frequency over time (Figure). Mean patient age was 64 10 years, 80.1% were men, and 24.5% had prior coronary artery bypass graft surgery. CTOs requiring the use of DCBs were less complex with alower J-CTO score (Multicenter CTO Registry of Japan) (2.1 1.2 vs 2.3 1.2; P ¼ 0.008), higher prevalence of in-stent restenosis (34.2% vs 15.5%; P < 0.001), and less moderate to severe calcification (32.3% vs 41.7%; P ¼ 0.010) and tortuosity (19.3% vs 25.9%; P ¼ 0.045). Lesions requiring DCBs were more frequently located in the right coronary artery (47.9%) and left anterior descending artery (34.0%). The mean number of DCBs was 1.3 0.6 per PCI, with a mean diameter of 3.3 2.4 mm, and mean length of 34.4 18.0 mm. A hybrid strategy was more frequently used (59.0%) than a DCB-only strategy. The primary reason for DCB use was in-stent restenosis (53.8%) followed by investment procedure (33.9%) and side branch treatment (12.3%). The most common successful CTO crossing technique was antegrade wiring (71.7%) followed by retrograde (16.2%) and antegrade dissection and re-entry (8.1%). Technical and procedural success and the incidence of major cardiac adverse events were similar in both groupsCONCLUSION DCB are increasingly being used in CTO PCI and are associated with high success and low complication rates.