Drug-Coated versus conventional balloon to improve recanalization of a coronary chronic total occlusion after failed attempt.

BackgroundChronic total occlusion (CTO) plaque modification (CTO-PM) is often used for unsuccessful CTO interventions. MethodsMulticenter, prospective study including consecutive patients with failed CTO recanalization. At the end of the failed procedure, patients received either conventional (CB) or drug-coated balloon (DCB) or at the operators discretion for CTO-PM and underwent new attempt of CTO recanalization [~]3 months later. ResultsA total of 55 patients were enrolled (DCB: 22; CB 33), with a median age of 66 years. Median J-score was 3 and CCS angina class III-IV was present in 40% of the patients. After the first CTO-PCI attempt no in hospital cardiac deaths were registered, with 3.6% rates of in-hospital myocardial infarction. The success rate of the second CTP PCI attempt was 86.8%, with periprocedural complication rate of 5.7% and without difference between DCB and CB groups. Compared with CB, in the DCB group, the second CTO-PCI required a shorter median fluoroscopy time (33 vs 60min, p<0.001), lower contrast volume (170 vs 321cc, p<0.001) and lower radiation dose (1.7 vs 3.3Gy, p<0.001). At 1-year follow up outcomes were comparable between the 2 strategies, target lesion failure occurred in 5.7% and major adverse cardiovascular events in 11.2%. ConclusionsPM after CTO recanalization failure is safe and warrants high success rates when 2nd attempt is performed. A DCB strategy for CTO-PM does not seem to ensure higher success or better clinical outcomes, but its use was associated with simpler staged procedures.