Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention

Suwetha Amsavelu, Georgios E. Christakopoulos, Aris Karatasakis, Krishna Patel, Bavana V. Rangan, Jeffrey Stetler, Michele Roesle, Erica Resendes, Jerrold Grodin, Shuaib Abdullah, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: There is ongoing controversy about the optimal crossing strategy selection for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially regarding the relative merits of antegrade dissection/re-entry and the retrograde approach. Methods: We retrospectively examined the clinical outcomes of 173 consecutive patients who underwent successful CTO PCI at our institution between January 2012 and March 2015. Results: The mean age was 65 ± 8 years, and 98% of the patients were men with a high prevalence of diabetes (60%), previous coronary artery bypass grafting (CABG) (31%), and previous PCI (54%). The successful CTO crossing strategy was antegrade wire escalation in 79 patients (45.5%), antegrade dissection/re-entry in 58 patients (33.5%), retrograde wire escalation in 11 patients (6.4%), and retrograde dissection and re-entry in 25 patients (14.5%). The retrograde approach was more commonly used in lesions with interventional collaterals (P <0.0001), moderate/severe calcification (P = 0.02), blunt stump (P = 0.01), and a higher Japan Chronic Total Occlusion score (P = 0.0002). Use of dissection and re-entry (both antegrade and retrograde) was associated with bifurcation and the distal cap (P = 0.004), longer CTO occlusion length (P <0.0001), and longer stent length (P <0.0001). Median follow-up was 11 months. The 12-month incidence of death, myocardial infarction, and the composite of acute coronary syndrome/target lesion revascularization/target vessel revascularization was 2.5%, 4.9%, and 24.4%, respectively, and was similar with intimal and subintimal crossing strategies. Conclusions: Antegrade dissection/re-entry and retrograde approaches are frequently used during CTO PCI and were associated with similarly favorable intermediate-term outcomes as antegrade wire escalation.

Original languageEnglish (US)
JournalCanadian Journal of Cardiology
DOIs
StateAccepted/In press - Nov 29 2015

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Percutaneous Coronary Intervention
Dissection
Tunica Intima
Acute Coronary Syndrome
Coronary Artery Bypass
Stents
Japan
Myocardial Infarction
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention. / Amsavelu, Suwetha; Christakopoulos, Georgios E.; Karatasakis, Aris; Patel, Krishna; Rangan, Bavana V.; Stetler, Jeffrey; Roesle, Michele; Resendes, Erica; Grodin, Jerrold; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Canadian Journal of Cardiology, 29.11.2015.

Research output: Contribution to journalArticle

Amsavelu, Suwetha ; Christakopoulos, Georgios E. ; Karatasakis, Aris ; Patel, Krishna ; Rangan, Bavana V. ; Stetler, Jeffrey ; Roesle, Michele ; Resendes, Erica ; Grodin, Jerrold ; Abdullah, Shuaib ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention. In: Canadian Journal of Cardiology. 2015.
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abstract = "Background: There is ongoing controversy about the optimal crossing strategy selection for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially regarding the relative merits of antegrade dissection/re-entry and the retrograde approach. Methods: We retrospectively examined the clinical outcomes of 173 consecutive patients who underwent successful CTO PCI at our institution between January 2012 and March 2015. Results: The mean age was 65 ± 8 years, and 98{\%} of the patients were men with a high prevalence of diabetes (60{\%}), previous coronary artery bypass grafting (CABG) (31{\%}), and previous PCI (54{\%}). The successful CTO crossing strategy was antegrade wire escalation in 79 patients (45.5{\%}), antegrade dissection/re-entry in 58 patients (33.5{\%}), retrograde wire escalation in 11 patients (6.4{\%}), and retrograde dissection and re-entry in 25 patients (14.5{\%}). The retrograde approach was more commonly used in lesions with interventional collaterals (P <0.0001), moderate/severe calcification (P = 0.02), blunt stump (P = 0.01), and a higher Japan Chronic Total Occlusion score (P = 0.0002). Use of dissection and re-entry (both antegrade and retrograde) was associated with bifurcation and the distal cap (P = 0.004), longer CTO occlusion length (P <0.0001), and longer stent length (P <0.0001). Median follow-up was 11 months. The 12-month incidence of death, myocardial infarction, and the composite of acute coronary syndrome/target lesion revascularization/target vessel revascularization was 2.5{\%}, 4.9{\%}, and 24.4{\%}, respectively, and was similar with intimal and subintimal crossing strategies. Conclusions: Antegrade dissection/re-entry and retrograde approaches are frequently used during CTO PCI and were associated with similarly favorable intermediate-term outcomes as antegrade wire escalation.",
author = "Suwetha Amsavelu and Christakopoulos, {Georgios E.} and Aris Karatasakis and Krishna Patel and Rangan, {Bavana V.} and Jeffrey Stetler and Michele Roesle and Erica Resendes and Jerrold Grodin and Shuaib Abdullah and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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T1 - Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention

AU - Amsavelu, Suwetha

AU - Christakopoulos, Georgios E.

AU - Karatasakis, Aris

AU - Patel, Krishna

AU - Rangan, Bavana V.

AU - Stetler, Jeffrey

AU - Roesle, Michele

AU - Resendes, Erica

AU - Grodin, Jerrold

AU - Abdullah, Shuaib

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2015/11/29

Y1 - 2015/11/29

N2 - Background: There is ongoing controversy about the optimal crossing strategy selection for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially regarding the relative merits of antegrade dissection/re-entry and the retrograde approach. Methods: We retrospectively examined the clinical outcomes of 173 consecutive patients who underwent successful CTO PCI at our institution between January 2012 and March 2015. Results: The mean age was 65 ± 8 years, and 98% of the patients were men with a high prevalence of diabetes (60%), previous coronary artery bypass grafting (CABG) (31%), and previous PCI (54%). The successful CTO crossing strategy was antegrade wire escalation in 79 patients (45.5%), antegrade dissection/re-entry in 58 patients (33.5%), retrograde wire escalation in 11 patients (6.4%), and retrograde dissection and re-entry in 25 patients (14.5%). The retrograde approach was more commonly used in lesions with interventional collaterals (P <0.0001), moderate/severe calcification (P = 0.02), blunt stump (P = 0.01), and a higher Japan Chronic Total Occlusion score (P = 0.0002). Use of dissection and re-entry (both antegrade and retrograde) was associated with bifurcation and the distal cap (P = 0.004), longer CTO occlusion length (P <0.0001), and longer stent length (P <0.0001). Median follow-up was 11 months. The 12-month incidence of death, myocardial infarction, and the composite of acute coronary syndrome/target lesion revascularization/target vessel revascularization was 2.5%, 4.9%, and 24.4%, respectively, and was similar with intimal and subintimal crossing strategies. Conclusions: Antegrade dissection/re-entry and retrograde approaches are frequently used during CTO PCI and were associated with similarly favorable intermediate-term outcomes as antegrade wire escalation.

AB - Background: There is ongoing controversy about the optimal crossing strategy selection for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially regarding the relative merits of antegrade dissection/re-entry and the retrograde approach. Methods: We retrospectively examined the clinical outcomes of 173 consecutive patients who underwent successful CTO PCI at our institution between January 2012 and March 2015. Results: The mean age was 65 ± 8 years, and 98% of the patients were men with a high prevalence of diabetes (60%), previous coronary artery bypass grafting (CABG) (31%), and previous PCI (54%). The successful CTO crossing strategy was antegrade wire escalation in 79 patients (45.5%), antegrade dissection/re-entry in 58 patients (33.5%), retrograde wire escalation in 11 patients (6.4%), and retrograde dissection and re-entry in 25 patients (14.5%). The retrograde approach was more commonly used in lesions with interventional collaterals (P <0.0001), moderate/severe calcification (P = 0.02), blunt stump (P = 0.01), and a higher Japan Chronic Total Occlusion score (P = 0.0002). Use of dissection and re-entry (both antegrade and retrograde) was associated with bifurcation and the distal cap (P = 0.004), longer CTO occlusion length (P <0.0001), and longer stent length (P <0.0001). Median follow-up was 11 months. The 12-month incidence of death, myocardial infarction, and the composite of acute coronary syndrome/target lesion revascularization/target vessel revascularization was 2.5%, 4.9%, and 24.4%, respectively, and was similar with intimal and subintimal crossing strategies. Conclusions: Antegrade dissection/re-entry and retrograde approaches are frequently used during CTO PCI and were associated with similarly favorable intermediate-term outcomes as antegrade wire escalation.

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