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

Athanasios Rempakos; Michaella Alexandrou; Bahadir Simsek; Spyridon Kostantinis; Judit Karacsonyi; Deniz Mutlu; Luiz F Ybarra; Rodrigo Bagur; James W Choi; Paul Poommipanit; Jaikirshan J Khatri; Rhian Davies; Stewart Benton; Sevket Gorgulu; Farouc A Jaffer; Raj Chandwaney; Wissam Jaber; Stephane Rinfret; William Nicholson; Lorenzo Azzalini; Kathleen E Kearney; Jimmy L Kerrigan; Elias V Haddad; Khaldoon Alaswad; Mir B Basir; Oleg Krestyaninov; Dmitrii Khelimskii; Nidal Abi-Rafeh; Ahmed ElGuindy; Omer Goktekin; Bavana V Rangan; Olga C Mastrodemos; Ahmed Al-Ogaili; Salman S Allana; Yader Sandoval; M Nicholas Burke; Emmanouil S Brilakis

doi:10.1016/j.jcin.2023.09.021

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

JACC Cardiovasc Interv. 2023 Nov 27;16(22):2736-2747. doi: 10.1016/j.jcin.2023.09.021. Epub 2023 Oct 23.

Authors

Athanasios Rempakos¹, Michaella Alexandrou¹, Bahadir Simsek¹, Spyridon Kostantinis¹, Judit Karacsonyi¹, Deniz Mutlu¹, Luiz F Ybarra², Rodrigo Bagur², James W Choi³, Paul Poommipanit⁴, Jaikirshan J Khatri⁵, Rhian Davies⁶, Stewart Benton⁶, Sevket Gorgulu⁷, Farouc A Jaffer⁸, Raj Chandwaney⁹, Wissam Jaber¹⁰, Stephane Rinfret¹⁰, William Nicholson¹⁰, Lorenzo Azzalini¹¹, Kathleen E Kearney¹¹, Jimmy L Kerrigan¹², Elias V Haddad¹², Khaldoon Alaswad¹³, Mir B Basir¹³, Oleg Krestyaninov¹⁴, Dmitrii Khelimskii¹⁴, Nidal Abi-Rafeh¹⁵, Ahmed ElGuindy¹⁶, Omer Goktekin¹⁷, Bavana V Rangan¹, Olga C Mastrodemos¹, Ahmed Al-Ogaili¹, Salman S Allana¹, Yader Sandoval¹, M Nicholas Burke¹, Emmanouil S Brilakis¹⁸

Affiliations

¹ Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
² London Health Sciences Centre, Western University, London, Ontario, Canada.
³ Texas Health Presbyterian Hospital, Dallas, Texas, USA.
⁴ University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
⁵ Cleveland Clinic, Cleveland, Ohio, USA.
⁶ WellSpan York Hospital, York, Pennsylvania, USA.
⁷ Biruni University Medical School, Istanbul, Turkey.
⁸ Massachusetts General Hospital, Boston, Massachusetts, USA.
⁹ Oklahoma Heart Institute, Tulsa, Oklahoma, USA.
¹⁰ Emory University Hospital Midtown, Atlanta, Georgia, USA.
¹¹ Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
¹² Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA.
¹³ Henry Ford Cardiovascular Division, Detroit, Michigan, USA.
¹⁴ Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia.
¹⁵ North Oaks Health System, Hammond, Louisiana, USA.
¹⁶ Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt.
¹⁷ Memorial Bahcelievler Hospital, Istanbul, Turkey.
¹⁸ Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. Electronic address: esbrilakis@gmail.com.

PMID: 37877912
DOI: 10.1016/j.jcin.2023.09.021

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.

Objectives: The aim of this study was to determine the frequency and outcomes of ADR use in a large multicenter CTO PCI registry.

Methods: The characteristics and outcomes of ADR were examined among 12,568 patients who underwent 12,841 CTO PCIs at 46 U.S. and non-U.S. centers between 2012 and 2023.

Results: ADR was used in 2,385 of the procedures (18.6%). ADR use declined from 37.9% in 2012 to 14.5% in 2022 (P < 0.001). Patients in whom ADR was used had a high prevalence of comorbidities. Compared with cases that did not use ADR, ADR cases had more complex angiographic characteristics, higher mean J-CTO (Multicenter CTO Registry in Japan) score (2.94 ± 1.11 vs 2.23 ± 1.26; P < 0.001), lower technical success (77.0% vs 89.3%; P < 0.001), and higher in-hospital major adverse cardiac events (3.7% vs 1.6%; P < 0.001). The use of the 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 (78%); however, its use has been decreasing, with STAR becoming the most used re-entry technique in 2022 (44% STAR vs 38% Stingray).

Conclusions: The use of ADR has been decreasing. ADR was used in more complex lesions and was associated with lower technical success and higher major adverse cardiac events compared with non-ADR cases. There has been a decrease in Stingray use and an increase in the use of STAR for re-entry.

Keywords: antegrade dissection and re-entry; chronic total occlusion; coronary artery disease; percutaneous coronary intervention.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Chronic Disease
Coronary Angiography
Coronary Occlusion* / diagnostic imaging
Coronary Occlusion* / etiology
Coronary Occlusion* / therapy
Dissection
Humans
Percutaneous Coronary Intervention*
Registries
Risk Factors
Treatment Outcome