TCT-400 In-Hospital Outcome of Antegrade Dissection Reentry in Left Anterior Descending Artery Chronic Total Occlusions: Patient Data Pooled Analysis of 4 Multicenter Registries
Recommended Citation
Boukhris M, Mutlu D, Rempakos A, Aboyans V, Rouchaud A, Alexandrou M, Strepkos D, Carvalho P, Quadros A, Dens J, Abi Rafeh N, Agostoni P, Alaswad K, Avran A, Belli K, Carlino M, Choi J, El Guindy A, Jaffer F, Khatri J, Khelimskii D, Knaapen P, la Manna A, Krestyaninov O, de Oliveira PP, Ojeda S, Padilla L, Pan M, Spratt J, Harada M, Tanabe M, Walsh S, Sandoval Y. TCT-400 In-Hospital Outcome of Antegrade Dissection Reentry in Left Anterior Descending Artery Chronic Total Occlusions: Patient Data Pooled Analysis of 4 Multicenter Registries. J Am Coll Cardiol 2024; 84(18):B114.
Document Type
Conference Proceeding
Publication Date
10-29-2024
Publication Title
J Am Coll Cardiol
Abstract
Background: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) depend on the target vessel. The left anterior descending (LAD) subtends the largest myocardial territory and gives several branches that could be compromised by extraplaque tracking during antegrade dissection/reentry (ADR). We compared the success and safety of ADR in LAD vs non-LAD CTO PCI. Methods: We analyzed the data of 20,431 CTO PCIs enrolled in 4 multicenter registries: the PROGRESS-CTO registry, the LATAM CTO registry, the RECHARGE registry, and an international 7-center registry. CTO PCIs were subdivided into LAD (n = 5,560) and non-LAD (n = 14,871). Technical success was defined as successful CTO revascularization with achievement of <30% residual diameter stenosis within the treated segment and restoration of grade 3 TIMI flow. Procedural success was defined as the achievement of technical success without any in-hospital major adverse cardiac events (MACE). Results: ADR was used in 4,945 procedures (24.2%) (LAD: n = 1,183 [21.3%], non-LAD: n = 3,762 [25.3%]). ADR was attempted in more complex CTOs in both LAD (J-CTO score: ADR 2.46 ± 1.14 vs non-ADR 1.91 ± 1.16; P < 0.001) and non-LAD CTO PCI (ADR 2.82 ± 1.15 vs non-ADR 2.26 ± 1.27; P < 0.001). In 81.8% of cases, ADR was used as a bail-out strategy, particularly in LAD (85.8% vs 80.4% non-LAD; P < 0.001). Stingray-based reentry was attempted in 31.5% of ADR cases (LAD 30.6% vs non-LAD 31.8%; P = 0.473). ADR was the final successful crossing strategy in 50.5% of ADR cases (LAD 49.6% vs non-LAD 50.8%; P = 0.489). Overall, technical and procedural success rates were higher in LAD than non-LAD cases ([88.4% vs 85.6%; P < 0.001] and [85.7% vs 82.8%; P < 0.001], respectively). Among ADR cases, LAD CTO PCI was associated with higher technical (81.1% vs 77.5%: P = 0.009) and procedural (76.5% vs 73.4%; P = 0.042) success, and similar in-hospital MACE (7.3% vs 6.0%; P = 0.114) than non-LAD CTO PCI. In LAD ADR cases, Stingray use was associated with higher technical (86.3% vs 78.7%; P = 0.004) and procedural (81.2% vs 74.6%; P = 0.022) success rates. Conclusions: ADR was used in almost one-fourth of CTO PCIs, especially in more complex CTOs and was associated with high success and acceptable MACE. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP).
Volume
84
Issue
18
First Page
B114
