E-13 | Percutaneous Coronary Interventions of Balloon Uncrossable Chronic Total Occlusions
Bibliographic record
Abstract
BackgroundBalloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing.MethodsWe analyzed the association between balloon uncrossable lesions (BU) and procedural outcomes of 6,883 chronic total occlusion (CTO) percutaneous coronary intervention (PCI)s performed between 2012 and 2021 at 36 centers.ResultsThe prevalence of balloon uncrossable lesions was 9.5%. Mean patient age was 64.2±10 years and 81% were men. Patients with balloon uncrossable lesions were older (67.4 ± 10 vs. 63.9 ± 10, p<0.001), more likely to have diabetes mellitus (50% vs. 42%, p<0.001) and prior coronary artery bypass graft surgery (40% vs. 26%, p<0.001) compared with patients who had balloon crossable lesions. Calcification (68% vs. 40%, p<0.001) and proximal vessel tortuosity (37% vs. 25%, p<0.001) were more common in balloon uncrossable lesions. Procedure time (133 [87, 199] vs. 111 [72, 165] min, p<0.001) was longer and air kerma radiation dose (2.60 [1.49, 4.20] vs. 1.98 [1.10, 3.40] min, p<0.001) was higher in balloon uncrossable lesions, and they also had lower technical (90% vs. 98%, p<0.001) and procedural success rates (87% vs. 97%, p<0.001) and higher major adverse complication event rates (3.21% vs. 1.46%, p<0.001). The techniques used for balloon uncrossable lesions and the associated technical success rates are shown in Figure 1.ConclusionsDisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; M. P. Patel: Abbott: Consulting; Cardiovascular Systems, Inc.: Consulting; Medtronic: Consulting; A. Elguindy: Honoraria: Medtronic, Boston Scientific, Asahi Intecc, Abbott Proctorship fees: Medtronic, Boston Scientific, Asahi Intecc, Terumo Educational grants: Medtronic: Consulting; B. Jefferson: honoraria/consulting/speaking fees from Abbott, Boston Scientific, CSI, Medtronic: Consulting; J. R. Wollmuth: reports serving as proctor/speaker/medical advisory board for Abbott Vascular, Boston Scientific and Abiomed, proctor for Asahi Intecc, and medical advisory board with Philips: Advisory Board/Board Member; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; Z. A. Ali: Abbott: Advisory Board/Board Member; Boston Scientific Corp.: Consulting and Speaker Bureau; Cardiovascular Systems, Inc.: Principal Investigator for a Research Study; Amgen: Advisory Board/Board Member; Astra Zeneca: Speaker Bureau; Shockwave Medical: Ownership Interests: Stocks, Stock Options; R. E. Davies: Medtronic: Speaker Bureau; Asahi Intec: Speaker Bureau; Shockwave: Advisory Board/Board Member; Siemens healthineers/Corindus: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; D. Doshi: speaker’s bureau for Abbott Vascular, Boston Scientific, and Medtronic and has research support from Biotronik: Consulting; M. B. Basir: consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, and Zoll.: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; J. Karacsonyi Nothing to disclose. O. Krestyaninov Nothing to disclose. D. Khelimskii Nothing to disclose. P. Poomipanit Nothing to disclose. J. W. Choi Nothing to disclose. Ş. Görgülü Nothing to disclose. M. Koutouzis Nothing to disclose. I. Tsiafoutis Nothing to disclose. A. M. Sheikh Nothing to disclose. B. Elbarouni Nothing to disclose. T. Patel Nothing to disclose. R. W. Yeh Nothing to disclose. A. J. Kirtane Nothing to disclose. M. McEntegart Nothing to disclose. A. Masoumi Nothing to disclose. S. Kostantinis Nothing to disclose. B. Simsek Nothing to disclose. B. V. Rangan Nothing to disclose. O. C. Mastrodemos Nothing to disclose. Y. B. Sandoval Nothing to disclose. M. S. Megaly Nothing to disclose. I. Ungi Nothing to disclose. N. Abi Rafeh Nothing to disclose. Ö. Göktekin Nothing to disclose. BackgroundBalloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. MethodsWe analyzed the association between balloon uncrossable lesions (BU) and procedural outcomes of 6,883 chronic total occlusion (CTO) percutaneous coronary intervention (PCI)s performed between 2012 and 2021 at 36 centers. We analyzed the association between balloon uncrossable lesions (BU) and procedural outcomes of 6,883 chronic total occlusion (CTO) percutaneous coronary intervention (PCI)s performed between 2012 and 2021 at 36 centers. ResultsThe prevalence of balloon uncrossable lesions was 9.5%. Mean patient age was 64.2±10 years and 81% were men. Patients with balloon uncrossable lesions were older (67.4 ± 10 vs. 63.9 ± 10, p<0.001), more likely to have diabetes mellitus (50% vs. 42%, p<0.001) and prior coronary artery bypass graft surgery (40% vs. 26%, p<0.001) compared with patients who had balloon crossable lesions. Calcification (68% vs. 40%, p<0.001) and proximal vessel tortuosity (37% vs. 25%, p<0.001) were more common in balloon uncrossable lesions. Procedure time (133 [87, 199] vs. 111 [72, 165] min, p<0.001) was longer and air kerma radiation dose (2.60 [1.49, 4.20] vs. 1.98 [1.10, 3.40] min, p<0.001) was higher in balloon uncrossable lesions, and they also had lower technical (90% vs. 98%, p<0.001) and procedural success rates (87% vs. 97%, p<0.001) and higher major adverse complication event rates (3.21% vs. 1.46%, p<0.001). The techniques used for balloon uncrossable lesions and the associated technical success rates are shown in Figure 1. The prevalence of balloon uncrossable lesions was 9.5%. Mean patient age was 64.2±10 years and 81% were men. Patients with balloon uncrossable lesions were older (67.4 ± 10 vs. 63.9 ± 10, p<0.001), more likely to have diabetes mellitus (50% vs. 42%, p<0.001) and prior coronary artery bypass graft surgery (40% vs. 26%, p<0.001) compared with patients who had balloon crossable lesions. Calcification (68% vs. 40%, p<0.001) and proximal vessel tortuosity (37% vs. 25%, p<0.001) were more common in balloon uncrossable lesions. Procedure time (133 [87, 199] vs. 111 [72, 165] min, p<0.001) was longer and air kerma radiation dose (2.60 [1.49, 4.20] vs. 1.98 [1.10, 3.40] min, p<0.001) was higher in balloon uncrossable lesions, and they also had lower technical (90% vs. 98%, p<0.001) and procedural success rates (87% vs. 97%, p<0.001) and higher major adverse complication event rates (3.21% vs. 1.46%, p<0.001). The techniques used for balloon uncrossable lesions and the associated technical success rates are shown in Figure 1. Conclusions DisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; M. P. Patel: Abbott: Consulting; Cardiovascular Systems, Inc.: Consulting; Medtronic: Consulting; A. Elguindy: Honoraria: Medtronic, Boston Scientific, Asahi Intecc, Abbott Proctorship fees: Medtronic, Boston Scientific, Asahi Intecc, Terumo Educational grants: Medtronic: Consulting; B. Jefferson: honoraria/consulting/speaking fees from Abbott, Boston Scientific, CSI, Medtronic: Consulting; J. R. Wollmuth: reports serving as proctor/speaker/medical advisory board for Abbott Vascular, Boston Scientific and Abiomed, proctor for Asahi Intecc, and medical advisory board with Philips: Advisory Board/Board Member; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; Z. A. Ali: Abbott: Advisory Board/Board Member; Boston Scientific Corp.: Consulting and Speaker Bureau; Cardiovascular Systems, Inc.: Principal Investigator for a Research Study; Amgen: Advisory Board/Board Member; Astra Zeneca: Speaker Bureau; Shockwave Medical: Ownership Interests: Stocks, Stock Options; R. E. Davies: Medtronic: Speaker Bureau; Asahi Intec: Speaker Bureau; Shockwave: Advisory Board/Board Member; Siemens healthineers/Corindus: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; D. Doshi: speaker’s bureau for Abbott Vascular, Boston Scientific, and Medtronic and has research support from Biotronik: Consulting; M. B. Basir: consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, and Zoll.: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; J. Karacsonyi Nothing to disclose. O. Krestyaninov Nothing to disclose. D. Khelimskii Nothing to disclose. P. Poomipanit Nothing to disclose. J. W. Choi Nothing to disclose. Ş. Görgülü Nothing to disclose. M. Koutouzis Nothing to disclose. I. Tsiafoutis Nothing to disclose. A. M. Sheikh Nothing to disclose. B. Elbarouni Nothing to disclose. T. Patel Nothing to disclose. R. W. Yeh Nothing to disclose. A. J. Kirtane Nothing to disclose. M. McEntegart Nothing to disclose. A. Masoumi Nothing to disclose. S. Kostantinis Nothing to disclose. B. Simsek Nothing to disclose. B. V. Rangan Nothing to disclose. O. C. Mastrodemos Nothing to disclose. Y. B. Sandoval Nothing to disclose. M. S. Megaly Nothing to disclose. I. Ungi Nothing to disclose. N. Abi Rafeh Nothing to disclose. Ö. Göktekin Nothing to disclose. K. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; M. P. Patel: Abbott: Consulting; Cardiovascular Systems, Inc.: Consulting; Medtronic: Consulting; A. Elguindy: Honoraria: Medtronic, Boston Scientific, Asahi Intecc, Abbott Proctorship fees: Medtronic, Boston Scientific, Asahi Intecc, Terumo Educational grants: Medtronic: Consulting; B. Jefferson: honoraria/consulting/speaking fees from Abbott, Boston Scientific, CSI, Medtronic: Consulting; J. R. Wollmuth: reports serving as proctor/speaker/medical advisory board for Abbott Vascular, Boston Scientific and Abiomed, proctor for Asahi Intecc, and medical advisory board with Philips: Advisory Board/Board Member; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; Z. A. Ali: Abbott: Advisory Board/Board Member; Boston Scientific Corp.: Consulting and Speaker Bureau; Cardiovascular Systems, Inc.: Principal Investigator for a Research Study; Amgen: Advisory Board/Board Member; Astra Zeneca: Speaker Bureau; Shockwave Medical: Ownership Interests: Stocks, Stock Options; R. E. Davies: Medtronic: Speaker Bureau; Asahi Intec: Speaker Bureau; Shockwave: Advisory Board/Board Member; Siemens healthineers/Corindus: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; D. Doshi: speaker’s bureau for Abbott Vascular, Boston Scientific, and Medtronic and has research support from Biotronik: Consulting; M. B. Basir: consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, and Zoll.: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; J. Karacsonyi Nothing to disclose. O. Krestyaninov Nothing to disclose. D. Khelimskii Nothing to disclose. P. Poomipanit Nothing to disclose. J. W. Choi Nothing to disclose. Ş. Görgülü Nothing to disclose. M. Koutouzis Nothing to disclose. I. Tsiafoutis Nothing to disclose. A. M. Sheikh Nothing to disclose. B. Elbarouni Nothing to disclose. T. Patel Nothing to disclose. R. W. Yeh Nothing to disclose. A. J. Kirtane Nothing to disclose. M. McEntegart Nothing to disclose. A. Masoumi Nothing to disclose. S. Kostantinis Nothing to disclose. B. Simsek Nothing to disclose. B. V. Rangan Nothing to disclose. O. C. Mastrodemos Nothing to disclose. Y. B. Sandoval Nothing to disclose. M. S. Megaly Nothing to disclose. I. Ungi Nothing to disclose. N. Abi Rafeh Nothing to disclose. Ö. Göktekin Nothing to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.028 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".