Techniques and material used in the percutaneous treatment of chronic coronary occlusions. Data from the CIBELES study

Abstract

Introduction: In recent years, various specific techniques and materials have been developed for the treatment of coronary chronic total occlusions (CTO).

Objective: To evaluate the current situation in the treatment of CTO (techniques and material) in our setting.

Methods: We evaluated data on techniques and material used in the CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial, a randomized comparison of sirolimus- and everolimus-eluting stents in 207 patients with CTO in 13 centers in Spain and Portugal.

Results: A radial approach was used in 23% of patients, and retrograde techniques were used in only 5%. A high number of balloons were used (2.2±0.9 per patient). Microcatheters were used in 33% of patients, and post-dilatation balloons in only 25%. The mean number of stents implanted per patient was 2.1±1.0, with a mean total stent length of 49±24 mm. Other devices and techniques used were: Tornus penetration catheter in 4% of patients, rotational atherectomy in 2%, and cutting balloon in 1%. Intracoronary ultrasound was used in only 6% of patients. In 34% of cases, operators used guidewires that were not specifically for CTO. Considerable variability between centers was detected in the use of different techniques, the highest and lowest variability being observed in the use of intracoronary ultrasound and the use of CTO guidewires, respectively.

Conclusions: In the CIBELES trial, techniques and devices specifically designed for the treatment of CTO were used in a relatively low proportion of patients. Considerable variability between centers was detected.

Keywords: Angioplastia coronária; Chronic occlusion; Coronary angioplasty; Coronary artery disease; Coronary stents; Doença coronária; Oclusões crónicas; Stents coronários.