Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking

Insights From the PROGRESS-CTO Registry

Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A. J.Conrad Smith, Barry Uretsky, Oleg Krestyaninov, Dmitrii Khelimskii, Elizabeth Holper, Srinivasa Potluri, R. Michael Wyman, David E. Kandzari & 16 others Santiago Garcia, Michalis Koutouzis, Ioannis Tsiafoutis, Wissam Jaber, Habib Samady, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Peter Tajti, Bavana Venkata Rangan, Shuaib M Abdullah, Subhash Banerjee, Emmanouil S Brilakis

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study. METHODS: We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry. RESULTS: Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13%; use increased from 0% in 2012 to 26% in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99% vs 100% vs 96.4%, respectively; P=.36), procedural success rates (93.2% vs 93.8% vs 96.3%, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4% vs 9.4% vs 3.6%, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P<.01), with a trend for lower patient air kerma radiation dose in the guide-catheter extension groups (4.11 Gray [IQR, 2.49-5.77 Gray] vs 3.19 Gray [IQR, 1.29-4.74 Gray] vs 3.47 Gray [IQR, 2.89-5.56 Gray]; P=.07). CONCLUSIONS: Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalThe Journal of invasive cardiology
Volume31
Issue number1
StatePublished - Jan 1 2019

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Registries
Dissection
Catheters
Percutaneous Coronary Intervention
Patient Identification Systems
Air
Radiation

Keywords

  • chronic total occlusion
  • guide-catheter extension
  • percutaneous coronary intervention
  • retrograde approach
  • reverse controlled antegrade and retrograde tracking

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking : Insights From the PROGRESS-CTO Registry. / Xenogiannis, Iosif; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul; Mahmud, Ehtisham; Choi, James W.; Burke, M. Nicholas; Doing, Anthony H.; Dattilo, Phil; Toma, Catalin; Smith, A. J.Conrad; Uretsky, Barry; Krestyaninov, Oleg; Khelimskii, Dmitrii; Holper, Elizabeth; Potluri, Srinivasa; Wyman, R. Michael; Kandzari, David E.; Garcia, Santiago; Koutouzis, Michalis; Tsiafoutis, Ioannis; Jaber, Wissam; Samady, Habib; Moses, Jeffrey W.; Lembo, Nicholas J.; Parikh, Manish; Kirtane, Ajay J.; Ali, Ziad A.; Doshi, Darshan; Tajti, Peter; Rangan, Bavana Venkata; Abdullah, Shuaib M; Banerjee, Subhash; Brilakis, Emmanouil S.

In: The Journal of invasive cardiology, Vol. 31, No. 1, 01.01.2019, p. 27-34.

Research output: Contribution to journalArticle

Xenogiannis, I, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, M, Mahmud, E, Choi, JW, Burke, MN, Doing, AH, Dattilo, P, Toma, C, Smith, AJC, Uretsky, B, Krestyaninov, O, Khelimskii, D, Holper, E, Potluri, S, Wyman, RM, Kandzari, DE, Garcia, S, Koutouzis, M, Tsiafoutis, I, Jaber, W, Samady, H, Moses, JW, Lembo, NJ, Parikh, M, Kirtane, AJ, Ali, ZA, Doshi, D, Tajti, P, Rangan, BV, Abdullah, SM, Banerjee, S & Brilakis, ES 2019, 'Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking: Insights From the PROGRESS-CTO Registry', The Journal of invasive cardiology, vol. 31, no. 1, pp. 27-34.
Xenogiannis, Iosif ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul ; Mahmud, Ehtisham ; Choi, James W. ; Burke, M. Nicholas ; Doing, Anthony H. ; Dattilo, Phil ; Toma, Catalin ; Smith, A. J.Conrad ; Uretsky, Barry ; Krestyaninov, Oleg ; Khelimskii, Dmitrii ; Holper, Elizabeth ; Potluri, Srinivasa ; Wyman, R. Michael ; Kandzari, David E. ; Garcia, Santiago ; Koutouzis, Michalis ; Tsiafoutis, Ioannis ; Jaber, Wissam ; Samady, Habib ; Moses, Jeffrey W. ; Lembo, Nicholas J. ; Parikh, Manish ; Kirtane, Ajay J. ; Ali, Ziad A. ; Doshi, Darshan ; Tajti, Peter ; Rangan, Bavana Venkata ; Abdullah, Shuaib M ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking : Insights From the PROGRESS-CTO Registry. In: The Journal of invasive cardiology. 2019 ; Vol. 31, No. 1. pp. 27-34.
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abstract = "OBJECTIVES: The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study. METHODS: We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry. RESULTS: Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13{\%}; use increased from 0{\%} in 2012 to 26{\%} in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99{\%} vs 100{\%} vs 96.4{\%}, respectively; P=.36), procedural success rates (93.2{\%} vs 93.8{\%} vs 96.3{\%}, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4{\%} vs 9.4{\%} vs 3.6{\%}, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P<.01), with a trend for lower patient air kerma radiation dose in the guide-catheter extension groups (4.11 Gray [IQR, 2.49-5.77 Gray] vs 3.19 Gray [IQR, 1.29-4.74 Gray] vs 3.47 Gray [IQR, 2.89-5.56 Gray]; P=.07). CONCLUSIONS: Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.",
keywords = "chronic total occlusion, guide-catheter extension, percutaneous coronary intervention, retrograde approach, reverse controlled antegrade and retrograde tracking",
author = "Iosif Xenogiannis and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Mitul Patel and Ehtisham Mahmud and Choi, {James W.} and Burke, {M. Nicholas} and Doing, {Anthony H.} and Phil Dattilo and Catalin Toma and Smith, {A. J.Conrad} and Barry Uretsky and Oleg Krestyaninov and Dmitrii Khelimskii and Elizabeth Holper and Srinivasa Potluri and Wyman, {R. Michael} and Kandzari, {David E.} and Santiago Garcia and Michalis Koutouzis and Ioannis Tsiafoutis and Wissam Jaber and Habib Samady and Moses, {Jeffrey W.} and Lembo, {Nicholas J.} and Manish Parikh and Kirtane, {Ajay J.} and Ali, {Ziad A.} and Darshan Doshi and Peter Tajti and Rangan, {Bavana Venkata} and Abdullah, {Shuaib M} and Subhash Banerjee and Brilakis, {Emmanouil S}",
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TY - JOUR

T1 - Comparison Between Traditional and Guide-Catheter Extension Reverse Controlled Antegrade Dissection and Retrograde Tracking

T2 - Insights From the PROGRESS-CTO Registry

AU - Xenogiannis, Iosif

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul

AU - Mahmud, Ehtisham

AU - Choi, James W.

AU - Burke, M. Nicholas

AU - Doing, Anthony H.

AU - Dattilo, Phil

AU - Toma, Catalin

AU - Smith, A. J.Conrad

AU - Uretsky, Barry

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Holper, Elizabeth

AU - Potluri, Srinivasa

AU - Wyman, R. Michael

AU - Kandzari, David E.

AU - Garcia, Santiago

AU - Koutouzis, Michalis

AU - Tsiafoutis, Ioannis

AU - Jaber, Wissam

AU - Samady, Habib

AU - Moses, Jeffrey W.

AU - Lembo, Nicholas J.

AU - Parikh, Manish

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Doshi, Darshan

AU - Tajti, Peter

AU - Rangan, Bavana Venkata

AU - Abdullah, Shuaib M

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVES: The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study. METHODS: We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry. RESULTS: Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13%; use increased from 0% in 2012 to 26% in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99% vs 100% vs 96.4%, respectively; P=.36), procedural success rates (93.2% vs 93.8% vs 96.3%, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4% vs 9.4% vs 3.6%, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P<.01), with a trend for lower patient air kerma radiation dose in the guide-catheter extension groups (4.11 Gray [IQR, 2.49-5.77 Gray] vs 3.19 Gray [IQR, 1.29-4.74 Gray] vs 3.47 Gray [IQR, 2.89-5.56 Gray]; P=.07). CONCLUSIONS: Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.

AB - OBJECTIVES: The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study. METHODS: We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry. RESULTS: Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13%; use increased from 0% in 2012 to 26% in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99% vs 100% vs 96.4%, respectively; P=.36), procedural success rates (93.2% vs 93.8% vs 96.3%, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4% vs 9.4% vs 3.6%, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P<.01), with a trend for lower patient air kerma radiation dose in the guide-catheter extension groups (4.11 Gray [IQR, 2.49-5.77 Gray] vs 3.19 Gray [IQR, 1.29-4.74 Gray] vs 3.47 Gray [IQR, 2.89-5.56 Gray]; P=.07). CONCLUSIONS: Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.

KW - chronic total occlusion

KW - guide-catheter extension

KW - percutaneous coronary intervention

KW - retrograde approach

KW - reverse controlled antegrade and retrograde tracking

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