TCT-422 Trends and Outcomes of Antegrade Dissection and Re-Entry in Chronic Total Occlusion Percutaneous Coronary Intervention
Recommended Citation
Rempakos A, Alexandrou M, Simsek B, Kostantinis S, Karacsonyi J, Mutlu D, Ybarra L, Bagur R, Choi J, Poommipanit P, Khatri J, Davies R, Benton S, Gorgulu S, Jaffer F, Chandwaney R, Jaber W, Rinfret S, Nicholson W, Azzalini L, Kerrigan J, Haddad E, Alaswad K, Krestyaninov O, Khelimskii D, Rafeh NA, Goktekin O, Rangan B, Mastrodemos O, Al-Ogaili A, Allana S, Burke MN, Sandoval Y, Brilakis E. TCT-422 Trends and Outcomes of Antegrade Dissection and Re-Entry in Chronic Total Occlusion Percutaneous Coronary Intervention. J Am Coll Cardiol 2023; 82(17 Suppl):B169-B170.
Document Type
Conference Proceeding
Publication Date
10-24-2023
Publication Title
J Am Coll Cardiol
Keywords
adult, chronic total occlusion, comorbidity, conference abstract, controlled study, dissection, female, human, incidence, major adverse cardiac event, major clinical study, male, outcome assessment, percutaneous coronary intervention, prevalence, risk assessment, surgery
Abstract
Background: The contemporary frequency and outcomes of antegrade dissection and re-entry (ADR) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 12,568 patients who underwent 12,841 CTO PCIs performed at 46 U.S. and non-U.S. centers between 2012 and 2023. Results: ADR was used in 2,385 (18.6%) of the procedures. ADR use declined from 37.9% in 2012 to 14.5% in 2022 (P < 0.001). Patients in whom ADR was used had a higher prevalence of comorbidities. CTOs treated with ADR were more likely to have complex angiographic characteristics and had higher mean J-CTO score (2.94 ± 1.11 vs 2.23 ± 1.26; P < 0.001). ADR cases had lower technical success (77.0% vs 89.3%; P < 0.001), and higher incidence of in-hospital major adverse cardiac events (MACE) (3.7% vs 1.6%; P < 0.001). The use of CrossBoss declined from 71% in 2012 to 1.4% in 2022 and was associated with higher technical success (87%) compared with wire-based techniques (73%). The Stingray device displayed higher technical success (86%) compared with subintimal tracking and re-entry (STAR) (74%) and limited antegrade subintimal tracking (LAST) (78%); however, its use has been decreasing, with STAR becoming the most used re-entry technique in 2022 (44% STAR vs 38% Stingray). [Formula presented] Conclusion: The use of ADR has been decreasing. ADR was used in more complex lesions and was associated with lower technical success and higher MACE, compared with non-ADR cases. There has been a decrease in Stingray use and an increase in the use of STAR for re-entry. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Volume
82
Issue
17 Suppl
First Page
B169-B170
