D-37 | Guide Catheter Extension Use in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS CTO Registry

There is limited data on the use of guide catheter extensions (GCE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the frequency and temporal trends of GCE use in a large multicenter CTO PCI registry. We compared the clinical and angiographic characteristics, and outcomes of cases with vs. without GCE use. A GCE was used in 4,106 of 14,521 CTO PCIs (28%) performed between 2012 to 2023. GCE use increased from 18.8% in 2012 to 29.9% in 2023 (P <0.0001). The most commonly used GCE size was 6Fr (45%), followed by 7Fr (34%), and 8Fr (21%). Patients that required GCE use had more comorbidities, such as diabetes (47% vs 42%, P <0.0001), prior coronary artery bypass surgery (40% vs 24%, P<0.0001), and prior PCI (40% vs 24%, P < 0.0001). GCE patients were more likely to have unfavorable lesion characteristics such as moderate to severe calcification (59% vs 40%, P < 0.0001), moderate to severe tortuosity (35% vs 28%, P<0.0001), and had higher J-CTO scores (2.78 ± 1.15 vs 2.20 ± 1.27, P<0.0001). Advanced techniques like the retrograde approach (44% vs 24%, P<0.0001) and antegrade dissection & re-entry (28% vs 17%, P <0.0001) were more likely to be used in GCE cases. Technical success (86.6% vs 86.8%, P = 0.816) was similar between the two groups. Major adverse cardiovascular events (MACE) (3.8% vs 2.4%, P<0.0001) and procedural complications (11.2% vs 8.7%, P<0.0001) were more frequent in the GCE group. GCE use in CTO PCI significantly increased between 2012 and 2023. Cases that required GCEs were more complex and had similar technical success, but higher incidence of MACE.