{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:26:04Z","timestamp":1772720764214,"version":"3.50.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Enabling strategies (ESs) are increasingly used during percutaneous coronary intervention for chronic total occlusive disease (CTO-PCI), enhancing procedural success. Using the British Cardiovascular Society dataset, we examined changes in the use of ESs and procedural\/clinical outcomes for CTO-PCI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              ESs were defined as intravascular ultrasound, rotational\/laser atherectomy, dual arterial access, use of microcatheters, penetration catheters or CrossBoss, and procedures categorized by number of ESs used. Data were analysed on all elective CTO-PCI procedures performed in England and Wales between 2006 and 2014. Multivariable logistic regression was used to identify predictors of procedural success. During 28\u2009050 CTO-PCIs, there were significant temporal increases in ES use. There was a stepwise increase in CTO success with increased ES use, with 83.8% of cases successful where \u22653 ESs were used. Overall, CTO-PCI success rate for the whole cohort increased from 55.4% in 2006 to 66.9% in 2014 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), but the greatest increase in procedural success was associated with \u22653 ES use. In multivariable analysis, any ES use and the number of ESs used were predictive of procedural success. Coronary perforation increased from 1.2% with zero ES use to 4.0% with \u22653 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). After adjustment, although arterial complication, in-hospital bleeding, in-hospital mortality, and major adverse cardiovascular or cerebrovascular events remained more likely with ES use, 30-day mortality was not significantly different between groups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>ES use during CTO-PCI was associated with significant improvements in CTO-PCI success. ES use was associated with increased procedural complications and in-hospital major adverse cardiovascular events, but not with 30-day mortality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.118.006436","type":"journal-article","created":{"date-parts":[[2018,10,12]],"date-time":"2018-10-12T09:06:33Z","timestamp":1539335193000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Procedural Success and Outcomes With Increasing Use of Enabling Strategies for Chronic Total Occlusion Intervention"],"prefix":"10.1161","volume":"11","author":[{"given":"Tim","family":"Kinnaird","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Cockburn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (J.C., D.H.-S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Sirker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University College Hospital, London, United Kingdom (A.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Ludman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"de Belder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elliot","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Bartholomew\u2019s Hospital, London, United Kingdom (E.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Strange","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamas","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, University Hospital of North Midlands, United Kingdom (M.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Hildick-Smith","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (J.C., D.H.-S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes 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Successful management of a distal vessel perforation through a single 8-French guide catheter: combining balloon inflation for bleeding control with coil embolization. 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