TCT-338 “Tip in/Rendez-vous” Technique in Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS CTO Registry

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Background: After successful retrograde crossing, wire externalization is the default strategy. “Tip-in/rendez-vous” technique is an alternative strategy that is less frequently used. The aim of the study was to assess procedural strategies and outcomes of “tip-in/rendez-vous” technique in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined clinical and angiographic characteristics, procedural techniques, and outcomes of 2,456 CTO PCIs with successful retrograde crossing performed at 44 U.S. and non-U.S. centers between 2012 and 2023. In-hospital major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, urgent repeat target-vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. Results: “Tip-in/rendez-vous” technique was performed in 73 (3.0%) cases and retrograde wire externalization in 2,383 (97.0%) cases. Compared with the CTO procedures with wire externalization, procedures requiring “tip-in/rendez-vous” required longer fluoroscopy times (86 [60, 118] minutes vs 74 [54, 99] minutes; P = 0.03], higher air kerma radiation dose (4.1 [2.4, 7.7] Gy vs 2.9 [1.7, 4.8] Gy; P = 0.001), and higher contrast volume (300 [185, 450] mL vs 230 [162, 320] mL; P = 0.002]. There was a trend toward lower technical success rate (94.5% vs 97.8%; P = 0.07) among lesions requiring “tip in/rendez-vous” technique. There were no significant differences in the overall procedural success rate (93.2% vs 94.8%; P = 0.53) and the rate of in-hospital MACE between the 2 groups (4.1% vs 3.4%; P = 0.74). Non-RCA target vessel, good distal landing zone, successful epicardial crossing, and proximal cap ambiguity were independently associated with higher likelihood of using “tip-in/rendez-vous” technique over wire externalization. Conclusion: “Tip-in/rendez-vous” technique is infrequently performed in retrograde CTO PCI. Compared with wire externalization, “tip-in/rendez-vous” technique in retrograde CTO PCI is associated with longer fluoroscopy times, higher air kerma radiation dose, higher contrast volume, and similar rates of technical and procedural success and in-hospital MACE. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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