The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry

Joren Maeremans, Simon Walsh, Paul Knaapen, James C. Spratt, Alexandre Avran, Colm G. Hanratty, Benjamin Faurie, Pierfrancesco Agostoni, Erwan Bressollette, Peter Kayaert, Alan J. Bagnall, Mohaned Egred, Dave Smith, Alexander Chase, Margaret B. McEntegart, William H. T. Smith, Alun Harcombe, Paul Kelly, John Irving, Elliot J. SmithJulian W. Strange, Joseph Dens (Lead / Corresponding author)

    Research output: Contribution to journalArticlepeer-review

    257 Citations (Scopus)


    Background: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.

    Objectives: The RECHARGE (REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom) registry aims to report achievable results using the hybrid algorithm.

    Methods: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.

    Results: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. The average Japanese CTO score was 2.0 ± 1.0, and was higher in the failure group (2.6 ± 0.6 vs. 1.9 ± 1.0; p < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm(2), respectively.

    Conclusions: High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators.

    Original languageEnglish
    Pages (from-to)1958-1970
    Number of pages13
    JournalJournal of the American College of Cardiology
    Issue number18
    Early online date24 Oct 2016
    Publication statusPublished - 1 Nov 2016


    • Chronic total occlusion
    • Hybrid
    • Percutaneous coronary intervention


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