TY - JOUR
T1 - Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross Peripheral Artery Chronic Total Occlusions
AU - Banerjee, Subhash
AU - Jeon-Slaughter, Haekyung
AU - Tsai, Shirling
AU - Mohammad, Atif
AU - Foteh, Mazin
AU - Abu-Fadel, Mazen
AU - Gigliotti, Osvaldo S.
AU - Cawich, Ian
AU - Rodriguez, Gerardo
AU - Kumbhani, Dharam
AU - Addo, Tayo
AU - Luna, Michael
AU - Das, Tony S.
AU - Prasad, Anand
AU - Armstrong, Ehrin J.
AU - Shammas, Nicolas W.
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/11/14
Y1 - 2016/11/14
N2 - 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.
AB - 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.
KW - chronic total occlusion
KW - cost-benefit analysis
KW - peripheral artery disease
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U2 - 10.1016/j.jcin.2016.08.010
DO - 10.1016/j.jcin.2016.08.010
M3 - Article
C2 - 27832850
AN - SCOPUS:84994406591
SN - 1936-8798
VL - 9
SP - 2243
EP - 2252
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 21
ER -