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Catheter Cardiovasc Interv. 2017 Nov 1;90(5):703-712. doi: 10.1002/ccd.26980. Epub 2017 Mar 15.

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

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Royal Melbourne Hospital, Department of Cardiology, Parkville VIC 3050, Melbourne, Australia.
Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland.
Freeman Hospital, Cardiothoracic Services, Newcastle upon Tyne, England.
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England.
Division Cardiology, St Michael's Hospital, University of Toronto, Canada.
The London Chest Hospital, Barts Health NHS Trust, London, England, United Kingdom.
Golden Jubilee National Hospital, West of Scotland Regional Heart and Lung Centre, Glasgow, Scotland.
Ninewells Hospital, Dundee, Scotland.
Bristol Heart Institute, Bristol, United Kingdom.
Forth Valley Royal Hospital, Larbert, United Kingdom.


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.


CrossBoss; angina; hybrid approach; revascularization; stent; stingray

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