The Hybrid Approach of Percutaneous Coronary Interventions for Chronic Total Occlusions

Dr. Peter Tajti of Abbott Northwestern Hospital discusses the study titled “The Hybrid Approach of Percutaneous Coronary Interventions for Chronic Total Occlusions” that was presented at the Society of Cardiovascular Angiography and Interventions (SCAI) 2018 Scientific Sessions.

The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on a diverse group of patients and operators on 2 continents.

Dr. Peter Tajti, MD is currently the postgraduate research fellow at the Minneapolis Heart Institute at Abbott Northwestern Hospital. He is also currently a Resident of Internal Medicine at the University of Szeged, Division of Invasive Cardiology in Hungary. He received his Medical Degree at the University of Szeged in 2015, and taught at the University of Szeged from 2011- 2015 in the Department of Anatomy as well as the Department of Pharmacology.

To know more about Dr. Tajti’s study, click here.

Trancript

Neal Howard: Welcome to the program. I’m your host, Neal Howard here on Health Professional Radio. Very glad that you could join us here on the program once again. Our guest today is going to talk about a recent study that was presented in our series on the Society of Cardiovascular Angiography and Interventions 2018 scientific sessions. Our guest is Dr. Peter Tajti representing Abbott Northwestern Hospital to talk about that study. Welcome to the program, doctor. How are you?

Dr. Peter Tajti: Good morning. I’m very good. I also would like to introduce the study behind PROGRESS-CTO, Dr. Brilakis is also here with us.

N: Thank you very much both of you for joining us today. Let’s jump right into this study and some of the revelations that came from it.

P: So the PROGRESS-CTO is an international multi-center registry that is collecting the patient information mostly from the United States centers but also from Russia. Registry started back in 2012 and it’s an ongoing program, ongoing registry and we presented our latest results at the SCAI meeting and there was also a simultaneous publication in JACC Cardiovascular Interventions.

N: Now, the title of the study The Hybrid Approach of Percutaneous Coronary Interventions for Chronic Total Occlusions, what were some of the methods employed behind your study?

P: So the hybrid algorithm was created back in 2012 by various very experienced CT operators using various techniques, under grade and retrograde techniques and combining them to improve the procedural outcomes of CT of PCI. This algorithm is an excellent tool for initial crossing strategy selection which is based upon for angiographic parameters which includes proximal lesion anatomy, the distal lesion segment and also lesion length and the collaterals. We are using this algorithm for treating CT Occlusions by selecting the most appropriate technique. Also, the very important part of the hybrid algorithm is to alternate between the crossing strategies not letting the procedure settle to save more contrast of volume and variation.

N: Was that the reason for the study? Because the traditional way of treating this PROGRESS-CTO took so much time and effort in order to properly address it.

Dr. Brilakis: Yes. I think this is jumping a little bit. I think Peter makes a great point. The problem with these lesions like imagine you have a pipe in this block and it’s very hard to get it open because it’s completely blocked and you don’t really know where you’re going. The usual way has been tried different things the same way again and again and see if it works which quite often it did not. The new approach is that it would try approach A. If it doesn’t work very quickly, go to approach B. If it doesn’t work, approach C and then keep on going on and on until we find the one that works versus trying the same thing again and again. So having these early change and tailoring the way we do this with the way the blockages, that’s what really makes the difference and makes the success rates get so much better than they used to be.

N: What about hospital stays, is that reduced as well?

B: The procedure is actually fairly short. It’s the same as the other … The majority of patients are going to go home the following day. The ones who have a complication or very sick for other reasons they may stay a little longer. But actually, the challenge, in this case, has been mainly being successful. The length of stay has been fairly short for most people before and now …

N: So basically the length of stay isn’t affected that much by the advancement in this procedure. It’s certainly a method of proper diagnosis and treatment a lot faster than in the traditional manner. Correct?

P: Actually, the procedural success rate is better using this algorithm. If we compare our results with prior studies in a selected patient population in the real world, the success of these complex procedures is around 60%. However, using and combining multiple approaches, you can facilitate a better lesion crossing and better treatment, the better success rate which is up to approximately 90% which is going to mean that out of the 10 patients who come to the hospital with this kind of problem may get the appropriate treatment in 9 of those 10 patients.

N: What do you see next for this study? Where do we go from here as far as this procedure is concerned?

P: The major focus from now should be to bridge the gap between inexperienced and experienced centers. So PROGRESS-CTO includes only high-volume experienced centers from two continents, however, in general, the cath labs might not have the volume to perform CTO PCI as we’re doing PROGRESS-CTO registry. So this is also a very important point. And the major focus from now is to just bridge the gap between the low volume inexperienced centers and the high-volume experienced centers to just have a more balanced and standardized patient treatment and referral system. We should I mean all of us should do it by educating and proctoring those low volume centers to improve the outcomes there as well.

N: Well, I appreciate you coming in today, both of you. As a matter of fact some great information in our ongoing series on the 2018 scientific sessions as a Society of Cardiovascular Angiography and Interventions. I thank you both for coming in today and speaking with us.

P: Thank you very much.

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