HydroDynamic Recanalization for Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.

BACKGROUND

HydroDynamic Recanalization (HDR) is a novel technique for crossing coronary chronic total occlusions (CTOs) that involves intraplaque contrast injection followed by polymer-jacketed guidewire advancement.

AIM: The aim of this study is to compare the technical and procedural outcomes, and safety of CTO PCIs performed with HDR versus (vs.) without HDR.

METHODS

We analyzed the baseline clinical and angiographic characteristics and outcomes of HDR-treated patients in the multicenter PROGRESS-CTO registry.

RESULTS

Of 1807 CTO percutaneous coronary interventions (PCIs) (1797 patients) performed in 2025, HDR was utilized in 90 (5%) cases. HDR patients had similar baseline clinical characteristics with non-HDR patients, although a history of prior PCI was more common among HDR patients (75.3% vs. 60.2%, p = 0.006). HDR-treated patients were less likely to have interventional collaterals (38.2% vs. 55.4%, p = 0.002) but more likely to have in-stent restenosis (35.6% vs. 14.9%, p < 0.001). HDR cases had higher prevalence of blunt/no stump (62.2% vs. 50.1%, p = 0.025), smaller lesion diameter (2.88 ± 0.67 vs. 3.03 ± 0.55, p = 0.011), and less frequently side branch at the proximal cap (43.7% vs. 64.0%, p < 0.001). They had higher J-CTO (2.63 ± 1.10 vs. 2.29 ± 1.14, p = 0.006), PROGRESS-CTO (1.33 ± 1.02 vs. 1.13 ± 0.93, p = 0.048) and PROGRESS-CTO MACE (3.06 ± 1.55 vs. 2.65 ± 1.67, p = 0.014) scores. Antegrade wiring was both the first and the most successful crossing strategy in both groups. HDR cases had significantly longer procedural (131 [107, 174] vs. 109 [74, 151] min, p < 0.001), fluoroscopy (48 [34, 70] vs. 39 [25, 61]) min, p = 0.001), and crossing (39 [22, 86] vs. 25 [11, 56] min, p < 0.001) time compared with non-HDR cases. Technical success was lower in HDR patients (80.0% vs. 88.5%, p = 0.024), while MACE (1.1% vs. 2.6%, p = 0.7) was not different between the two groups.

CONCLUSIONS

HDR was performed in 5% of CTO PCIs in 2025, in more complex lesions and was associated with lower technical success but similar MACE compared with patients who underwent CTO PCI without HDR.