TCT-422 Trends and Outcomes of Antegrade Dissection and Re-Entry in Chronic Total Occlusion Percutaneous Coronary Intervention

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Conference Proceeding

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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)

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