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Observational Study
. 2025 May;105(6):1493-1501.
doi: 10.1002/ccd.31472. Epub 2025 Mar 10.

Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Deniz Mutlu  1 , Dimitrios Strepkos  1   2 , Ozgur Selim Ser  1 , Pedro E P Carvalho  1 , Michaella Alexandrou  1 , Sandeep Jalli  1 , Lorenzo Azzalini  2 , Luiz Ybarra  3 , Khaldoon Alaswad  4 , Farouc A Jaffer  5 , Rhian Davies  6 , Bavana V Rangan  1 , Yader Sandoval  1 , M Nicholas Burke  1 , Sevket Gorgulu  7 , Emmanouil S Brilakis  1 ; PROGRESS‐CTO Investigators
Collaborators, Affiliations
Observational Study

Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Deniz Mutlu et al. Catheter Cardiovasc Interv. 2025 May.

Abstract

Background: The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Aims: To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.

Methods: We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.

Results: Among 1353 CTO PCIs with failed AW with a single wire, traditional parallel wiring (n = 1081) or DLMC-assisted parallel wiring (n = 272) were utilized at the operator's discretion. The baseline characteristics of patients were similar in both groups except for higher prevalence of diabetes mellitus, and lower prevalence of hypertension, prior heart failure, prior MI and cerebrovascular disease in DLMC patients. Lesions in the DLMC group were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate/severe calcification, and had higher J-CTO score (2.6 ± 1.0 vs. 2.1 ± 1.3, p < 0.001). Technical (87.1% vs. 74.3%, p < 0.001) and procedural (83.8% vs. 75.5%, p = 0.001) success and the incidence of in-hospital major cardiac adverse events (MACE) (4.8% vs. 2.0%, p = 0.020) were higher in the DLMC group. In propensity score matching analysis, DLMC-assisted wiring was associated with higher technical success (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.54, p = 0.002) and no significant difference in MACE (OR 2.00, 95% CI 0.89-4.50, p = 0.093).

Conclusions: In lesions that could not be crossed with AW, DLMC-assisted parallel wiring was associated with a higher likelihood of technical success, without an increased risk of MACE, compared with traditional parallel wiring.

Trial registration: ClinicalTrials.gov NCT02061436.

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References

    1. A. Rempakos, M. Alexandrou, D. Mutlu, et al., “Predictors of Successful Primary Antegrade Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention,” Journal of Invasive Cardiology 36, no. 6 (2024).
    1. E. B. Wu, E. S. Brilakis, K. Mashayekhi, et al., “Global Chronic Total Occlusion Crossing Algorithm,” Journal of the American College of Cardiology 78 (2021): 840–853.
    1. S. A. Harding, E. B. Wu, S. Lo, et al., “A New Algorithm for Crossing Chronic Total Occlusions From the Asia Pacific Chronic Total Occlusion Club,” JACC: Cardiovascular Interventions 10 (2017): 2135–2143.
    1. A. R. Galassi, G. S. Werner, M. Boukhris, et al., “Percutaneous Recanalisation of Chronic Total Occlusions: 2019 Consensus Document From the Eurocto Club,” EuroIntervention 15 (2019): 198–208.
    1. S. A. Pyxaras, A. R. Galassi, G. S. Werner, et al., “Dual Lumen Microcatheters for Recanalisation of Chronic Total Occlusions: A Eurocto Club Expert Panel Report,” EuroIntervention 17 (2021): e966–e970.

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