Author + information
- Received April 6, 2016
- Revision received July 6, 2016
- Accepted August 11, 2016
- Published online November 14, 2016.
- Subhash Banerjee, MDa,b,∗ (, )
- Haekyung Jeon-Slaughter, PhDa,b,
- Shirling Tsai, MDa,b,
- Atif Mohammad, MDa,
- Mazin Foteh, MDc,
- Mazen Abu-Fadel, MDd,
- Osvaldo S. Gigliotti, MDe,
- Ian Cawich, MDf,
- Gerardo Rodriguez, MD, PhDf,
- Dharam Kumbhani, MDa,
- Tayo Addo, MDa,
- Michael Luna, MDa,
- Tony S. Das, MDg,
- Anand Prasad, MDh,
- Ehrin J. Armstrong, MDi,
- Nicolas W. Shammas, MDj and
- Emmanouil S. Brilakis, MD, PhDa,b
- aUniversity of Texas Southwestern Medical Center, Dallas, Texas
- bVA North Texas Health Care System, Dallas, Texas
- cCardiothoracic and Vascular Surgeons, Austin, Texas
- dOklahoma University Health Science Center, Oklahoma City, Oklahoma
- eSeton Medical Center, Austin, Texas
- fArkansas Heart Hospital, Little Rock, Arkansas
- gWalnut Hill Medical Center, Dallas, Texas
- hUniversity of Texas at San Antonio, San Antonio, Texas
- iDenver VA Medical Center, Denver, Colorado
- jMidwest Cardiovascular Research Foundation, Davenport, Iowa
- ↵∗Reprint requests and correspondence:
Dr. Subhash Banerjee, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, 4500 S. Lancaster Road, 111a, Dallas, Texas 75216.
Objectives The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs.
Background Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices.
Methods The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO.
Results Of all 3,234 treated lesions, 42% (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82% of CTOs, whereas dedicated CTO devices were used in 18% (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74% vs. 65%; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3% vs. 17.2%; p = 0.02) and amputation rates (2.8% vs. 8.5%; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure.
Conclusions An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.
Dr. Banerjee has received research and educational grants from Boston Scientific and Merck; and consulting and speaking honoraria from Medtronic, Cardiovascular Systems, Inc., and Gore. Dr. Mohammad has received speaking honoraria from Medicure. Dr. Addo has received speaking honoraria from AstraZeneca and Merck. Dr. Cawich has received a consulting fee from Avinger. Dr. Armstrong has received consulting and speaking honoraria from Abbott Vascular, Boston Scientific, Cardiovascular Systems, Medtronic, Merck, and Spectranetics. Dr. Das has received consulting and speaking honoraria from Abbott Vascular, Cordis, Cardinal, and Boston Scientific. Dr. Gigliotti has received research funding from Abbott Vascular, Medtronic, Bard, Janssen, and Bristol-Myers Squibb; and speaking honoraria from AstraZeneca and Terumo. Dr. Prasad has received research funding from Osprey and Medtronic; and speaking honoraria from St. Jude Medical, AstraZeneca, and Gilead. Dr. Shammas has received educational and research funding from Boston Scientific, Janssen, Gilead, Novartis, and Trainer Covidien. Dr. Brilakis has received research grants from Infraredx, Boston Scientific; and consulting honoraria and speaking fees from Abbott Vascular, Asahi, Cardinal Health, Elsevier, GE Healthcare, and St. Jude Medical. Dr. Brilakis’s spouse is an employee of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 6, 2016.
- Revision received July 6, 2016.
- Accepted August 11, 2016.
- American College of Cardiology Foundation