D-55 | Use of plaque modification microcatheters in chronic total occlusion percutaneous coronary interventions for: Insights from the PROGRESS-CTO registry

There is limited information on the use of plaque modification microcatheters (Tornus [Asahi Medical] and Turnpike Gold [Teleflex]) in contemporary chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). We evaluated the frequency of use and outcomes of plaque modification microcatheters in an international registry (PROGRESS-CTO [NCT02061436]), between 2012-2023 at 43 centers. Plaque modification microcatheters were utilized in 219 cases (1.4%; Tornus in 56% and Turnpike Gold in 44%) (Figure 1A) with decreasing frequency over time (Figure 1B). Mean patient age was 65 ± 9.6, 84% were men, and 32.5% had prior coronary artery bypass graft surgery. CTOs requiring use of plaque modification microcatheters were more complex with a higher J-CTO score (2.62 ± 1.15 vs. 2.38 ± 1.26, p=0.005) and higher prevalence of moderate to severe calcification (74.9% vs. 45.7%, p<0.001). Lesions required plaque modification microcatheters were more frequently located in the right coronary artery (61.3%) and left circumflex artery (20.3%). The most common successful CTO crossing technique was antegrade (95.8%), followed by retrograde true to true wiring (4.2%). Technical (87.1% vs. 81%, p=0.258) and procedural (85.5% vs. 80%, p=0.328) success and the incidence of major cardiac adverse events (2.4% vs. 3.1%, p=1.00) were similar with Tornus and Turnpike Gold use. (Figure 1C) Procedure time was also similar in both groups (137 [95-184] vs. 119 [89-196], p=0.360). Plaque modification microcatheters are infrequently utilized in CTO-PCI and are associated with high success and acceptable complication rates.