Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross Peripheral Artery Chronic Total Occlusions

Subhash Banerjee, MD, Haekyung Jeon-Slaughter, PHD, Shirling Tsai, MD, Atif Mohammad, MD, Mazin Foteh, MD, Mazen Abu-Fadel, MD, Osvaldo S. Gigliotti, MD, Ian Cawich, MD, Gerardo Rodriguez, MD, PHD, Dharam Kumbhani, MD, Tayo Addo, MD, Michael Luna, MD, Tony S. Das, MD, Anand Prasad, MD, Ehrin J. Armstrong, MD,iNicolas W. Shammas, MD, Emmanouil S. Brilakis, MD, PHD

Objectives: The aim of this study was to assess actual procedural costs and outcomes comparing wire-catheter and dedicated chronic total occlusion (CTO) device strategies to cross peripheral artery CTOs.

Background: Peripheral artery CTO interventions are frequently performed, but there are limited data on actual procedural costs and outcomes comparing wire-catheter and dedicated CTO devices.

Methods: The XLPAD (Excellence in Peripheral Artery Disease Intervention) registry (NCT01904851) was accessed to retrospectively compare cost and 30-day and 12-month outcomes of wire-catheter and crossing device strategies for treatment of infrainguinal peripheral artery CTO.

Results: Of all 3,234 treated lesions, 42% (n = 1,362) were CTOs in 1,006 unique patients. Wire-catheter approaches were used in 82% of CTOs, whereas dedicated CTO devices were used in 18% (p < 0.0001). CTO crossing device use was associated with significantly higher technical success (74% vs. 65%; p < 0.0001) and mean procedure cost ($7,800.09 vs. $4,973.24; p < 0.0001). Because 12-month repeat revascularization (11.3% vs. 17.2%; p = 0.02) and amputation rates (2.8% vs. 8.5%; p = 0.002) in the CTO crossing device arm were lower compared with the wire-catheter group, the net cost for an initial CTO crossing device strategy was $423.80 per procedure.

Conclusions: An initial wire-catheter approach to cross a peripheral artery CTO is most frequently adopted. The use of dedicated CTO crossing devices provides significantly higher technical success and lower reintervention and amputation rates, at a net cost of $423.80 per procedure at 12 months.

Keywords: chronic total occlusion; cost-benefit analysis; peripheral artery disease.

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