Abstract 19494: Percutaneous Coronary Intervention of Two Chronic Total Occlusions in the Same Procedure: Efficacy, Safety and Efficiency Measures

Introduction: Limited data is available on the efficacy, safety and efficiency of percutaneous coronary intervention (PCI) of two chronic total occlusions (CTOs) during the same procedure. Methods: We examined the clinical and angiographic characteristics of patients who underwent CTO PCI between 2012 and 2016 in a multicenter registry. Results: PCI of two CTOs during the same procedure was performed in 39 of 1,313 procedures (3%). As compared with patients who underwent PCI of a single CTO, those who underwent PCI of two CTOs had similar baseline clinical characteristics but were more likely to have circumflex CTO PCI (32% vs. 22% for single targets, p=0.049). They also had lower angiographic complexity (moderate/severe calcification: 38% vs. 54%, p=0.01, J-CTO score 2.1±1.4 vs. 2.6±1.2, p=0.005) and were less likely to undergo retrograde crossing (26% vs. 41%, p=0.008). Overall technical success was 88% and was similar between the two groups (87% vs. 89%, p=0.715, Figure). In the two-CTO group, both CTOs were successfully recanalized in 30 (77%), one CTO in 8 (21%) and none in 1 (3%) procedures. However, two-target procedures were associated with a higher incidence of in-hospital stroke (5.1% vs. 0.2%, p=0.005) and a trend for higher incidence of major adverse cardiovascular events (MACE, 7.7% vs. 2.6%, p=0.088) and coronary perforation (7.7% vs. 3.0%, p=0.096). In addition, two-CTO procedures more often included use of a left ventricular assist device (12.8% vs. 5.4%, p=0.064), and required more contrast (median [interquartile range]: 370 [223 - 445] vs. 260 [195 - 350] ml, p Conclusions: PCI of two CTOs during the same procedure is infrequent and is attempted in angiographically less challenging lesions with high technical success rates, but may be associated with increased risk for adverse events.