Procedural and longer-term outcomes of wire- versus device-based antegrade dissection and re-entry techniques for the percutaneous revascularization of coronary chronic total occlusions

Azzalini, Lorenzo; Dautov, Rustem; Brilakis, Emmanouil S.; Ojeda, Soledad; Benincasa, Susanna; Bellini, Barbara; Karatasakis, Aris; Chavarría, Jorge; Rangan, Bavana V.; Pan, Manuel; Carlino, Mauro; Colombo, Antonio; Rinfret, Stéphane

doi:10.1016/j.ijcard.2016.11.273

Cited by 55 publications

(58 citation statements)

References 17 publications

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“…If there are poor retrograde collaterals then re‐entry will need to be performed as part of an ADR strategy most commonly using the Crossboss and Stingray system. Procedural success with use of re‐entry devices vary with operator experience with success rates varying between 67% and 87% in various registries . Aside from operator experience one of the main determinants of the success of Stingray re‐entry is the quality of the landing zone in the distal vessel.…”

Section: Discussionmentioning

confidence: 99%

The “side‐BASE technique”: Combined side branch anchor balloon and balloon assisted sub‐intimal entry to resolve ambiguous proximal cap chronic total occlusions

Roy

Hill

Spratt

2017

Cathet Cardio Intervent

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Failure to penetrate the proximal cap or cross with equipment remains the most frequent cause of procedural failure in CTO PCI. In the "BASE" technique concerns were raised over the risk of proximal side branch loss. We here describe the evolution of this technique and highlight examples where the sub-intimal space was accessed proximal to the occlusion by using the side branch. This technique can be of use both in resolving proximal cap ambiguity and also in cases where there is difficulty crossing a resistant proximal cap.

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Section: Discussionmentioning

confidence: 99%

The “side‐BASE technique”: Combined side branch anchor balloon and balloon assisted sub‐intimal entry to resolve ambiguous proximal cap chronic total occlusions

Roy

Hill

Spratt

2017

Cathet Cardio Intervent

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“…Because the vessel is totally occluded, a CTO can be crossed through the luminal plaque or around the lesion through the subintimal space by means of a DR technique. Higher rates of restenosis and repeat target vessel revascularization after the usage of wire‐based DR techniques have been reported previously . After the introduction of more controlled device‐based DR techniques, however, wire‐based DR techniques are increasingly being used as a bailout strategy when other strategies in CTO PCI fail.…”

Section: Discussionmentioning

confidence: 92%

Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Schumacher

Driessen

Stuijfzand

et al. 2018

Cathet Cardio Intervent

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Background The benefits of chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. The aim of this study was to assess the effects of CTO PCI on absolute myocardial perfusion, as compared with PCI of hemodynamically significant non‐CTO lesions. Methods Consecutive patients with a preserved left ventricular ejection fraction (≥50%) and a CTO or non‐CTO lesion, in whom [15O]H2O positron emission tomography was performed prior and after successful PCI, were included. Change in quantitative (hyperemic) myocardial blood flow (MBF), coronary flow reserve (CFR) and perfusion defect size (in myocardial segments) were compared between CTOs and non‐CTO lesions. Results In total 92 patients with a CTO and 31 patients with a non‐CTO lesion were included. CTOs induced larger perfusion defect sizes (4.51 ± 1.69 vs. 3.23 ± 2.38 segments, P < 0.01) with lower hyperemic MBF (1.30 ± 0.37 vs. 1.58 ± 0.62 mL·min−1·g−1, P < 0.01) and similarly impaired CFR (1.66 ± 0.75 vs. 1.89 ± 0.77, P = 0.17) compared with non‐CTO lesions. After PCI both hyperemic MBF and CFR increased similarly between groups (P = 0.57 and 0.35) to normal ranges with higher hyperemic MBF values in non‐CTO compared with CTO (2.89 ± 0.94 vs. 2.48 ± 0.73 mL·min−1·g−1, P = 0.03). Perfusion defect sizes decreased similarly after CTO PCI and non‐CTO PCI (P = 0.14), leading to small residual defect sizes in both groups (1.15 ± 1.44 vs. 0.61 ± 1.45 segments, P = 0.054). Conclusions Myocardial perfusion findings are slightly more hampered in patients with a CTO before and after PCI. Percutaneous revascularization of CTOs, however, improves absolute myocardial perfusion similarly to PCI of hemodynamically significant non‐CTO lesions, leading to satisfying results.

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“…Several strategies have been introduced in case the retrograde approach is not feasible. The subintimal tracking and re‐entry technique (STAR) technique and the recent antegrade dissection re‐entry system might increase the successful rate of wire re‐entry into true lumen. However, these strategies might be associated with limited successful rate, long subintimal stenting, and potential risk of losing side‐branches.…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound guided wiring re‐entry technique for complex chronic total occlusions

Huang

Teng

Hsueh

et al. 2018

J Interven Cardiology

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Procedural and longer-term outcomes of wire- versus device-based antegrade dissection and re-entry techniques for the percutaneous revascularization of coronary chronic total occlusions

Cited by 55 publications

References 17 publications

The “side‐BASE technique”: Combined side branch anchor balloon and balloon assisted sub‐intimal entry to resolve ambiguous proximal cap chronic total occlusions

The “side‐BASE technique”: Combined side branch anchor balloon and balloon assisted sub‐intimal entry to resolve ambiguous proximal cap chronic total occlusions

Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Intravascular ultrasound guided wiring re‐entry technique for complex chronic total occlusions

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