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

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background There are few data regarding the procedural and follow-up outcomes of different antegrade dissection/re-entry (ADR) techniques for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We compiled a multicenter registry of consecutive patients undergoing ADR-based CTO PCI at four high-volume specialized institutions. Patients were divided according to the specific ADR technique used: subintimal tracking and re-entry (STAR), limited antegrade subintimal tracking (LAST), or device-based with the CrossBoss/Stingray system (Boston Scientific, Marlborough, MA). Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and target-vessel revascularization) on follow-up were the main outcome of this study. Independent predictors of MACE were sought with Cox regression analysis. Results A total of 223 patients were included (STAR n = 39, LAST n = 68, CrossBoss/Stingray n = 116). Baseline characteristics were similar across groups. Technical and procedural success was lower with STAR (59% and 59%), as compared with LAST (96% and 96%) and CrossBoss/Stingray (89% and 87%; p < 0.001 for both). At 24-month follow-up, MACE rates were higher in STAR (15.4%) and LAST (17.5%), as compared with device-based ADR with CrossBoss/Stingray (4.3%, p = 0.02), driven by TVR (7.7% vs. 15.5% vs. 3.1%, respectively; p = 0.02). Multivariable Cox regression analysis identified wire-based ADR (STAR and LAST) and total stent length as independent predictors of MACE. Conclusions In this multicenter cohort of patients undergoing CTO PCI with ADR techniques, STAR had lower success rates, as compared with the CrossBoss/Stingray system and LAST. The CrossBoss/Stingray system was independently associated with lower risk of MACE on follow-up, as compared with wire-based ADR techniques.

Original languageEnglish (US)
Pages (from-to)78-83
Number of pages6
JournalInternational Journal of Cardiology
Volume231
DOIs
StatePublished - Mar 15 2017

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Percutaneous Coronary Intervention
Dissection
Equipment and Supplies
Regression Analysis
Stents
Registries
Myocardial Infarction
Outcome Assessment (Health Care)

Keywords

  • Antegrade
  • Chronic total occlusion
  • Dissection
  • Percutaneous coronary intervention
  • Re-entry

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

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.

In: International Journal of Cardiology, Vol. 231, 15.03.2017, p. 78-83.

Research output: Contribution to journalArticle

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. / 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. In: International Journal of Cardiology. 2017 ; Vol. 231. pp. 78-83.
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abstract = "Background There are few data regarding the procedural and follow-up outcomes of different antegrade dissection/re-entry (ADR) techniques for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We compiled a multicenter registry of consecutive patients undergoing ADR-based CTO PCI at four high-volume specialized institutions. Patients were divided according to the specific ADR technique used: subintimal tracking and re-entry (STAR), limited antegrade subintimal tracking (LAST), or device-based with the CrossBoss/Stingray system (Boston Scientific, Marlborough, MA). Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and target-vessel revascularization) on follow-up were the main outcome of this study. Independent predictors of MACE were sought with Cox regression analysis. Results A total of 223 patients were included (STAR n = 39, LAST n = 68, CrossBoss/Stingray n = 116). Baseline characteristics were similar across groups. Technical and procedural success was lower with STAR (59{\%} and 59{\%}), as compared with LAST (96{\%} and 96{\%}) and CrossBoss/Stingray (89{\%} and 87{\%}; p < 0.001 for both). At 24-month follow-up, MACE rates were higher in STAR (15.4{\%}) and LAST (17.5{\%}), as compared with device-based ADR with CrossBoss/Stingray (4.3{\%}, p = 0.02), driven by TVR (7.7{\%} vs. 15.5{\%} vs. 3.1{\%}, respectively; p = 0.02). Multivariable Cox regression analysis identified wire-based ADR (STAR and LAST) and total stent length as independent predictors of MACE. Conclusions In this multicenter cohort of patients undergoing CTO PCI with ADR techniques, STAR had lower success rates, as compared with the CrossBoss/Stingray system and LAST. The CrossBoss/Stingray system was independently associated with lower risk of MACE on follow-up, as compared with wire-based ADR techniques.",
keywords = "Antegrade, Chronic total occlusion, Dissection, Percutaneous coronary intervention, Re-entry",
author = "Lorenzo Azzalini and Rustem Dautov and Brilakis, {Emmanouil S.} and Soledad Ojeda and Susanna Benincasa and Barbara Bellini and Aris Karatasakis and Jorge Chavarr{\'i}a and Rangan, {Bavana V.} and Manuel Pan and Mauro Carlino and Antonio Colombo and St{\'e}phane Rinfret",
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T1 - 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

AU - Azzalini, Lorenzo

AU - Dautov, Rustem

AU - Brilakis, Emmanouil S.

AU - Ojeda, Soledad

AU - Benincasa, Susanna

AU - Bellini, Barbara

AU - Karatasakis, Aris

AU - Chavarría, Jorge

AU - Rangan, Bavana V.

AU - Pan, Manuel

AU - Carlino, Mauro

AU - Colombo, Antonio

AU - Rinfret, Stéphane

PY - 2017/3/15

Y1 - 2017/3/15

N2 - Background There are few data regarding the procedural and follow-up outcomes of different antegrade dissection/re-entry (ADR) techniques for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We compiled a multicenter registry of consecutive patients undergoing ADR-based CTO PCI at four high-volume specialized institutions. Patients were divided according to the specific ADR technique used: subintimal tracking and re-entry (STAR), limited antegrade subintimal tracking (LAST), or device-based with the CrossBoss/Stingray system (Boston Scientific, Marlborough, MA). Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and target-vessel revascularization) on follow-up were the main outcome of this study. Independent predictors of MACE were sought with Cox regression analysis. Results A total of 223 patients were included (STAR n = 39, LAST n = 68, CrossBoss/Stingray n = 116). Baseline characteristics were similar across groups. Technical and procedural success was lower with STAR (59% and 59%), as compared with LAST (96% and 96%) and CrossBoss/Stingray (89% and 87%; p < 0.001 for both). At 24-month follow-up, MACE rates were higher in STAR (15.4%) and LAST (17.5%), as compared with device-based ADR with CrossBoss/Stingray (4.3%, p = 0.02), driven by TVR (7.7% vs. 15.5% vs. 3.1%, respectively; p = 0.02). Multivariable Cox regression analysis identified wire-based ADR (STAR and LAST) and total stent length as independent predictors of MACE. Conclusions In this multicenter cohort of patients undergoing CTO PCI with ADR techniques, STAR had lower success rates, as compared with the CrossBoss/Stingray system and LAST. The CrossBoss/Stingray system was independently associated with lower risk of MACE on follow-up, as compared with wire-based ADR techniques.

AB - Background There are few data regarding the procedural and follow-up outcomes of different antegrade dissection/re-entry (ADR) techniques for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We compiled a multicenter registry of consecutive patients undergoing ADR-based CTO PCI at four high-volume specialized institutions. Patients were divided according to the specific ADR technique used: subintimal tracking and re-entry (STAR), limited antegrade subintimal tracking (LAST), or device-based with the CrossBoss/Stingray system (Boston Scientific, Marlborough, MA). Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and target-vessel revascularization) on follow-up were the main outcome of this study. Independent predictors of MACE were sought with Cox regression analysis. Results A total of 223 patients were included (STAR n = 39, LAST n = 68, CrossBoss/Stingray n = 116). Baseline characteristics were similar across groups. Technical and procedural success was lower with STAR (59% and 59%), as compared with LAST (96% and 96%) and CrossBoss/Stingray (89% and 87%; p < 0.001 for both). At 24-month follow-up, MACE rates were higher in STAR (15.4%) and LAST (17.5%), as compared with device-based ADR with CrossBoss/Stingray (4.3%, p = 0.02), driven by TVR (7.7% vs. 15.5% vs. 3.1%, respectively; p = 0.02). Multivariable Cox regression analysis identified wire-based ADR (STAR and LAST) and total stent length as independent predictors of MACE. Conclusions In this multicenter cohort of patients undergoing CTO PCI with ADR techniques, STAR had lower success rates, as compared with the CrossBoss/Stingray system and LAST. The CrossBoss/Stingray system was independently associated with lower risk of MACE on follow-up, as compared with wire-based ADR techniques.

KW - Antegrade

KW - Chronic total occlusion

KW - Dissection

KW - Percutaneous coronary intervention

KW - Re-entry

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