24 Drug coated balloon-only angioplasty in chronic total occlusions, a UK single centre experience

Objective Chronic total occlusions (CTO) are encountered in 15%–30% of patients referred for coronary angiography. We report outcomes of Drug Coated Balloon (DCB) – only angioplasty for CTO’s in a UK high volume PCI centre. Methods Retrospectively we identified 41 consecutive patients with 44 CTO’s treated from 14/12/2011 to 01/06/2016. Clinical outcomes were obtained from the clinic follow up letters and up-to-date mortality data from the Demographic Batch Service Bureau of the Health and Social Care Information Centre. Results Mean (SD) age 62.1 (9.5) years, 85.4% males, 34.1% Japanese CTO score of ≥2% and 40.9% had a score of 1. 81.8% de novo lesions, 43.2% multi-vessel disease, 47.7% LAD lesions. Dual access was used in 52.3%, anterograde wiring technique was successful in 97.7%. Mean (SD) DCB diameter was 2.8 (0.6) mm and mean (SD) length of treated segment was 41 (26) mm. There were 15 (34.1%) coronary dissections and two required bail-out stenting. There was one non-cardiac death but no cardiac deaths at a mean (SD) follow up period of 630 (347) days. After a mean (SD) clinic follow up period of 313 (304) days there were 3 (6.8%) target lesion revascularisations, 1 (2.3%) staged target vessel revascularisation (TVR) and 1 (2.3%) non- target vessel related non ST elevation myocardial infarction. Major adverse cardiac event rate was 9.8%. 17 (41.5%) had follow up angiography and no re-occlusions. Conclusion DCB-only angioplasty to CTOs appears to be a safe and effective treatment in the medium term follow up. This is the largest cohort reported and the first in the UK.