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

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

Athanasios Rempakos  1 , Michaella Alexandrou  1 , Bahadir Simsek  1 , Spyridon Kostantinis  1 , Judit Karacsonyi  1 , Deniz Mutlu  1 , Luiz F Ybarra  2 , Rodrigo Bagur  2 , James W Choi  3 , Paul Poommipanit  4 , Jaikirshan J Khatri  5 , Rhian Davies  6 , Stewart Benton  6 , Sevket Gorgulu  7 , Farouc A Jaffer  8 , Raj Chandwaney  9 , Wissam Jaber  10 , Stephane Rinfret  10 , William Nicholson  10 , Lorenzo Azzalini  11 , Kathleen E Kearney  11 , Jimmy L Kerrigan  12 , Elias V Haddad  12 , Khaldoon Alaswad  13 , Mir B Basir  13 , Oleg Krestyaninov  14 , Dmitrii Khelimskii  14 , Nidal Abi-Rafeh  15 , Ahmed ElGuindy  16 , Omer Goktekin  17 , Bavana V Rangan  1 , Olga C Mastrodemos  1 , Ahmed Al-Ogaili  1 , Salman S Allana  1 , Yader Sandoval  1 , M Nicholas Burke  1 , Emmanouil S Brilakis  18
Affiliations
Free article
Multicenter Study

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

Athanasios Rempakos et al. JACC Cardiovasc Interv. .
Free article

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.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Ybarra is a consultant for SoundBite Medical; and has received speaker honoraria for Abbott Vascular. Dr Rinfret is a consultant for Boston Scientific, Teleflex, Abbott Vascular, Biotronik, and SoundBite Medical; has received fees from Abbott Vascular, Abiomed, Boston Scientific, and SoundBite Medical; and has been a consultant for Teleflex. Dr Choi is an advisory board member for Medtronic. Dr Poommipanit is a consultant for Asahi Intecc and Abbott Vascular. Dr Khatri has received personal honoraria for proctoring and speaking from Abbott Vascular, Medtronic, Terumo, Shockwave, and Boston Scientific. Dr Davies has received speaking honoraria from Abiomed, Asahi Intecc, Boston Scientific, Medtronic, Shockwave and Teleflex; and serves on advisory boards for Abiomed, Avinger, Boston Scientific, Medtronic, and Rampart. Dr Jaffer has conducted sponsored research for Canon, Siemens, Shockwave, Teleflex, Mercator, and Boston Scientific; has been a consultant for Boston Scientific, Siemens, Magenta Medical, IMDS, Asahi Intecc, Biotronik, Philips, and Intravascular Imaging; has equity interest in Intravascular Imaging and DurVena; and has the right to receive royalties through Massachusetts General Hospital licensing arrangements with Terumo, Canon, and SpectraWAVE. Dr Jaber has received consulting fees from Medtronic; and has received proctoring fees from Abbott. Dr Nicholson has been a proctor and a Speakers Bureau and advisory board member for Abbott Vascular, Boston Scientific, and Asahi Intecc; and has intellectual property with Vascular Solutions. Dr Azzalini has received consulting fees from Teleflex, Abiomed, GE Healthcare, Asahi Intecc, Philips, Abbott Vascular, Reflow Medical, and Cardiovascular Systems. Dr Alaswad has been a consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and Cardiovascular Systems. Dr Abi-Rafeh has received proctor and speaker honoraria from Boston Scientific and Shockwave Medical. Dr ElGuindy has received consulting honoraria from Medtronic, Boston Scientific, Asahi Intecc, and Terumo; and has received proctorship fees from Medtronic, Boston Scientific, Asahi Intecc, and Terumo. Dr Allana is a consultant for Abiomed and Boston Scientific. Dr Brilakis has received consulting and speaker honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (Board of Directors), Cardiovascular Systems, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, Teleflex, and Terumo; has received research support from Boston Scientific and GE Healthcare; is an owner of Hippocrates; and is a shareholder in MHI Ventures, Cleerly Health, and Stallion Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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