Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic Total Occlusions

doi:10.1016/j.jcin.2025.04.035

Coronary disease & ACSCohort study

Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic Total Occlusions

JACC Cardiovasc IntervPublished 9 Jun 2025

Registry-based cohort study
European registry (ERCTO)

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Authors' conclusion

Applying ACPMDs in severely calcified CTO to PCI was associated with higher technical success and lower MACCE rates.

Study context

Population: Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCIs) enrolled in the European Registry of Chronic Total Occlusion, 2021–2023
Participants: 15,329 CTO PCIs

Exposure: PCI of severely calcified CTO with vs without advanced calcific plaque modification devices (ACPMDs)
ACPMDn = 787
non-ACPMDn = 2,253reference

Main finding

As reported in the abstract

Technical success and periprocedural and in-hospital major adverse cardiac and cerebrovascular events (MACCE)

Technical success

P = 0.001

ACPMD97.6%

non-ACPMD79.1%

Periprocedural and in-hospital MACCE

P = 0.001

ACPMD1.8%

non-ACPMD3.5%

Observational data: associations, not effects.

Further findings

Antegrade wiring

P < 0.001

ACPMD77.9%

non-ACPMD49.2%

Outcome	Lower odds vs non-ACPMD ←→ Higher odds vs non-ACPMD	OR (95% CI)	P value
Severe calcium and technical failure or MACCE — Severe calcium vs non-ACPMD · technical failure · independently associated		3.13 (2.43–4.09)	P < 0.001
Severe calcium and technical failure or MACCE — Severe calcium vs non-ACPMD · MACCE · independently associated		0.88 (0.58–1.35)	P = 0.15
Extraplaque crossing and MACCE — antegrade dissection and re-entry without retrograde contribution vs non-ACPMD · independently associated		3.12 (1.79–4.20)	P < 0.001
Extraplaque crossing and MACCE — antegrade dissection and re-entry with retrograde contribution vs non-ACPMD · independently associated		3.12 (1.67–4.11)	P = 0.049
Extraplaque crossing and MACCE — retrograde dissection and re-entry vs non-ACPMD · independently associated		1.90 (1.25–2.86)	P = 0.002
	0.20.5125Odds ratio (log scale)

Original publication

Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic Total Occlusions. JACC Cardiovasc Interv. Published 9 June 2025. doi:10.1016/j.jcin.2025.04.035

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Summarised from the published abstract; every number is checked against it