Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking: Insights From the PROGRESS-CTO Registry

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The Journal of invasive cardiology


OBJECTIVES: The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study.

METHODS: We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry.

RESULTS: Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13%; use increased from 0% in 2012 to 26% in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99% vs 100% vs 96.4%, respectively; P=.36), procedural success rates (93.2% vs 93.8% vs 96.3%, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4% vs 9.4% vs 3.6%, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P

CONCLUSIONS: Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.

Medical Subject Headings

Aged; Angioplasty, Balloon, Coronary; Cardiac Catheterization; Cardiac Catheters; Chronic Disease; Cohort Studies; Coronary Angiography; Coronary Occlusion; Female; Humans; Internationality; Male; Middle Aged; Patient Safety; Prognosis; Registries; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome

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