Clinical and Angiographic Outcomes of Crossing Techniques for Coronary Chronic Total Occlusions: the ISAR-CTO Registry

Overview

Journal EuroIntervention

Specialties Cardiology & Vascular Diseases
Pharmacology

Date 2021 Mar 1

PMID 33646124

Citations 3

Authors

Erion Xhepa

Salvatore Cassese

Gjin Ndrepepa

Michael Joner

Sebastian Kufner

Alp Aytekin

Anna Lena Lahmann

Felix Voll

Michele Fusaro

Susanne Pinieck

Heribert Schunkert

Adnan Kastrati

Massimiliano Fusaro

Affiliations

Soon will be listed here.

Abstract

Background: Clinical and angiographic outcomes following recanalisation of coronary chronic total occlusions (CTO) through contemporary dissection and re-entry techniques (DART) as opposed to intraplaque techniques remain controversial.

Aims: The aim of this study was to compare clinical and angiographic outcomes following subintimal and intraplaque CTO recanalisation.

Methods: A total of 454 consecutive patients undergoing successful CTO recanalisation (473 vessels) were included. Intraplaque techniques were used in 403 (85.2%) and DART in 70 (14.8%) vessels. Surveillance angiography was scheduled at 6-9 months and clinical follow-up was performed up to 12 months.

Results: There were no significant differences in terms of the cumulative incidence of MACE (p=0.908) or binary restenosis (p=0.320) between the two groups. There was no independent correlation between recanalisation technique and MACE occurrence or in-segment binary restenosis. Target lesion revascularisation (TLR) was performed in 60 (17.5%) and 12 (18.1%) (p=0.719) lesions, respectively. The occurrence of occlusive restenosis was low (7 [2.3%] vs 1 [1.6%]; p=0.824) and comparable between groups.

Conclusions: Contemporary DART are associated with similar midterm clinical and angiographic outcomes compared to intraplaque recanalisation. The rate of occlusive restenosis was low and comparable in both groups. Regardless of recanalisation technique, the overall incidences of binary restenosis and TLR following CTO recanalisation remain higher than those reported for non-CTO PCI.

Citing Articles

Dissection and Re-entry Techniques for Chronic Total Occlusion Percutaneous Coronary Intervention.

Masoomi R, Boukhris M, Moscardelli S, Azzalini L Interv Cardiol. 2024; 19:e16.

PMID: 39309300 PMC: 11413985. DOI: 10.15420/icr.2024.04.

Procedural Results and Long-term Outcome of Chronic Total Occlusion Percutaneous Coronary Intervention in a UK Non-surgical Centre.

Gilpin T, Maznyczka A, Anantharam B, Dana A Interv Cardiol. 2024; 19:e05.

PMID: 38808283 PMC: 11131147. DOI: 10.15420/icr.2023.23.

[Technical armamentarium for chronic total occlusion of coronary vessels].

Voll F, Kuna C, Kufner S, Cassese S Herz. 2021; 46(5):406-418.

PMID: 34398249 DOI: 10.1007/s00059-021-05053-y.

References

Teeuwen K, van der Schaaf R, Adriaenssens T, Koolen J, Smits P, Henriques J . Randomized Multicenter Trial Investigating Angiographic Outcomes of Hybrid Sirolimus-Eluting Stents With Biodegradable Polymer Compared With Everolimus-Eluting Stents With Durable Polymer in Chronic Total Occlusions: The PRISON IV Trial. JACC Cardiovasc Interv. 2017; 10(2):133-143. DOI: 10.1016/j.jcin.2016.10.017. View

Hasegawa K, Tsuchikane E, Okamura A, Fujita T, Yamane M, Oikawa Y . Incidence and impact on midterm outcome of intimal versus subintimal tracking with both antegrade and retrograde approaches in patients with successful recanalisation of chronic total occlusions: J-PROCTOR 2 study. EuroIntervention. 2016; 12(15):e1868-e1873. DOI: 10.4244/EIJ-D-16-00557. View

Cutlip D, Windecker S, Mehran R, Boam A, Cohen D, van Es G . Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007; 115(17):2344-51. DOI: 10.1161/CIRCULATIONAHA.106.685313. View

Valenti R, Vergara R, Migliorini A, Parodi G, Carrabba N, Cerisano G . Predictors of reocclusion after successful drug-eluting stent-supported percutaneous coronary intervention of chronic total occlusion. J Am Coll Cardiol. 2013; 61(5):545-50. DOI: 10.1016/j.jacc.2012.10.036. View

Harding S, Wu E, Lo S, Lim S, Ge L, Chen J . A New Algorithm for Crossing Chronic Total Occlusions From the Asia Pacific Chronic Total Occlusion Club. JACC Cardiovasc Interv. 2017; 10(21):2135-2143. DOI: 10.1016/j.jcin.2017.06.071. View

Kotsia A, Navara R, Michael T, Sherbet D, Roesle M, Christopoulos G . The AngiographiC Evaluation of the Everolimus-Eluting Stent in Chronic Total Occlusion (ACE-CTO) Study. J Invasive Cardiol. 2015; 27(9):393-400. View

Karatasakis A, Danek B, Karacsonyi J, Azzalini L, Carlino M, Rinfret S . Mid-term outcomes of chronic total occlusion percutaneous coronary intervention with subadventitial vs. intraplaque crossing: A systematic review and meta-analysis. Int J Cardiol. 2018; 253:29-34. DOI: 10.1016/j.ijcard.2017.08.044. View

Brilakis E, Grantham J, Rinfret S, Wyman R, Nicholas Burke M, Karmpaliotis D . A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012; 5(4):367-79. DOI: 10.1016/j.jcin.2012.02.006. View

Werner G, Emig U, Mutschke O, Schwarz G, Bahrmann P, Figulla H . Regression of collateral function after recanalization of chronic total coronary occlusions: a serial assessment by intracoronary pressure and Doppler recordings. Circulation. 2003; 108(23):2877-82. DOI: 10.1161/01.CIR.0000100724.44398.01. View

10.

Rinfret S, Barbosa Ribeiro H, Nguyen C, Nombela-Franco L, Urena M, Rodes-Cabau J . Dissection and re-entry techniques and longer-term outcomes following successful percutaneous coronary intervention of chronic total occlusion. Am J Cardiol. 2014; 114(9):1354-60. DOI: 10.1016/j.amjcard.2014.07.067. View

11.

Zeger S, Liang K . Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986; 42(1):121-30. View

12.

Azzalini L, Dautov R, Brilakis E, Ojeda S, Benincasa S, Bellini B . Impact of crossing strategy on midterm outcomes following percutaneous revascularisation of coronary chronic total occlusions. EuroIntervention. 2017; 13(8):978-985. DOI: 10.4244/EIJ-D-16-01010. View

13.

Shah P . Management of coronary chronic total occlusion. Circulation. 2011; 123(16):1780-4. DOI: 10.1161/CIRCULATIONAHA.110.972802. View

14.

Wilson W, Walsh S, Bagnall A, Yan A, Hanratty C, Egred M . One-year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re-entry techniques. Catheter Cardiovasc Interv. 2017; 90(5):703-712. DOI: 10.1002/ccd.26980. View

15.

Cassese S, Byrne R, Tada T, Pinieck S, Joner M, Ibrahim T . Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography. Heart. 2013; 100(2):153-9. DOI: 10.1136/heartjnl-2013-304933. View

16.

Walsh S, Hanratty C, McEntegart M, Strange J, Rigger J, Henriksen P . Intravascular Healing Is Not Affected by Approaches in Contemporary CTO PCI: The CONSISTENT CTO Study. JACC Cardiovasc Interv. 2020; 13(12):1448-1457. DOI: 10.1016/j.jcin.2020.03.032. View

17.

Xhepa E, Cassese S, Rroku A, Joner M, Pinieck S, Ndrepepa G . Subintimal Versus Intraplaque Recanalization of Coronary Chronic Total Occlusions: Mid-Term Angiographic and OCT Findings From the ISAR-OCT-CTO Registry. JACC Cardiovasc Interv. 2019; 12(19):1889-1898. DOI: 10.1016/j.jcin.2019.04.049. View

18.

Maeremans J, Walsh S, Knaapen P, Spratt J, Avran A, Hanratty C . The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry. J Am Coll Cardiol. 2016; 68(18):1958-1970. DOI: 10.1016/j.jacc.2016.08.034. View

19.

Amsavelu S, Christakopoulos G, Karatasakis A, Patel K, Rangan B, Stetler J . Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention. Can J Cardiol. 2016; 32(10):1239.e1-1239.e7. DOI: 10.1016/j.cjca.2016.01.020. View

20.

Tibshirani R . The lasso method for variable selection in the Cox model. Stat Med. 1997; 16(4):385-95. DOI: 10.1002/(sici)1097-0258(19970228)16:4<385::aid-sim380>3.0.co;2-3. View