Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention

Amsavelu, Suwetha; Christakopoulos, Georgios E.; Karatasakis, Aris; Patel, Krishna S.; Rangan, Bavana V.; Stetler, Jeffrey; Roesle, Michele; Resendes, Erica; Grodin, Jerrold; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1016/j.cjca.2016.01.020

Cited by 19 publications

(19 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 12‐month incidence of death, myocardial infarction, and the composite of acute coronary syndrome/TLR/TVR was 2.5%, 4.9%, and 24.4%, respectively, and was similar with true‐to‐true and subadventitial techniques. Again, crossing technique was not an independent predictor of adverse events .…”

Section: Outcomes Of Subadventitial Dissection/re‐entry Techniques Inmentioning

confidence: 73%

“…Registry indicated that 42% of successful CTO PCIs were performed using either an antegrade or a retrograde dissection/re‐entry technique . Several multicenter and single‐center registries showed that these techniques are safe and effective approaches for CTO PCI.…”

Section: Outcomes Of Subadventitial Dissection/re‐entry Techniques Inmentioning

confidence: 99%

“…Few studies have analyzed the long‐term outcomes of dissection/re‐entry techniques (Supporting Information) . STAR‐based techniques are associated with high incidence of restenosis on follow‐up, and this is mitigated to a certain extent by achievement of good runoff .…”

Section: Outcomes Of Subadventitial Dissection/re‐entry Techniques Inmentioning

confidence: 99%

See 2 more Smart Citations

Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of “vessel architecture”

Azzalini

Carlino

Brilakis

et al. 2017

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc.

show abstract

Section: Outcomes Of Subadventitial Dissection/re‐entry Techniques Inmentioning

confidence: 73%

Section: Outcomes Of Subadventitial Dissection/re‐entry Techniques Inmentioning

confidence: 99%

See 1 more Smart Citation

Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of “vessel architecture”

Azzalini

Carlino

Brilakis

et al. 2017

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

show abstract

“…Data regarding outcomes with modern techniques are much more promising, which likely relates to the more favourable distal run‐off achievable with targeted and controlled re‐entry. Three single‐centre North American studies have demonstrated no difference in adverse clinical events during intermediate‐term follow‐up between those treated with DART (antegrade or retrograde) versus conventional wire escalation strategies. A sub‐analysis of the J PROCTOR registry, which used IVUS to detect subintimal guidewire tracking found greater late lumen loss in the sub‐intimal tracking group, however, this did not translate into an increase in clinical events .…”

Section: Discussionmentioning

confidence: 99%

One‐year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re‐entry techniques

Wilson

Walsh²,

Bagnall

et al. 2017

Cathet Cardio Intervent

View full text Add to dashboard Cite

We aimed to determine clinical outcomes 1 year after successful chronic total occlusion (CTO) PCI and, in particular, whether use of dissection and re-entry strategies affects clinical outcomes. Hybrid approaches have increased the procedural success of CTO percutaneous coronary intervention (PCI) but longer-term outcomes are unknown, particularly in relation to dissection and re-entry techniques. Data were collected for consecutive CTO PCIs performed by hybrid-trained operators from 7 United Kingdom (UK) centres between 2012 and 2014. The primary endpoint (death, myocardial infarction, unplanned target vessel revascularization) was measured at 12 months along with angina status. One-year follow up data were available for 96% of successful cases (n = 805). In total, 85% of patients had a CCS angina class of 2-4 prior to CTO PCI. Final successful procedural strategy was antegrade wire escalation 48%; antegrade dissection and re-entry (ADR) 21%; retrograde wire escalation 5%; retrograde dissection and re-entry (RDR) 26%. Overall, 47% of CTOs were recanalized using dissection and re-entry strategies. During a mean follow up of 11.5 ± 3.8 months, the primary endpoint occurred in 8.6% (n = 69) of patients (10.3% (n = 39/375) in DART group and 7.0% (n = 30/430) in wire-based cases). The majority of patients (88%) had no or minimal angina (CCS class 0 or 1). ADR and RDR were used more frequently in more complex cases with greater disease burden, however, the only independent predictor of the primary endpoint was lesion length. CTO PCI in complex lesions using the hybrid approach is safe, effective and has a low one-year adverse event rate. The method used to recanalize arteries was not associated with adverse outcomes. © 2017 Wiley Periodicals, Inc.

show abstract

“…This has been a concern for both ADR and retrograde dissection and re-entry (RDR) ( Table 2) (15)(16)(17)(18)(19)(20). Several studies have shown favorable longterm outcomes with use of ADR, but have been limited by small size and relatively short duration of follow-up.…”

mentioning

confidence: 99%

Does the hybrid algorithm has real impact on long-term outcomes or should only be used as a valuable approach for CTO crossing?

Tajti

Brilakis

2018

J. Thorac. Dis.

Self Cite

View full text Add to dashboard Cite

show abstract

Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention

Cited by 19 publications

References 32 publications

Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of “vessel architecture”

Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of “vessel architecture”

One‐year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re‐entry techniques

Does the hybrid algorithm has real impact on long-term outcomes or should only be used as a valuable approach for CTO crossing?

Contact Info

Product

Resources

About