TY - JOUR
T1 - Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry
AU - Danek, Barbara Anna
AU - Karatasakis, Aris
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Yeh, Robert W.
AU - Jaffer, Farouc A.
AU - Patel, Mitul
AU - Bahadorani, John
AU - Lombardi, William L.
AU - Wyman, Michael R.
AU - Grantham, J. Aaron
AU - Doing, Anthony
AU - Moses, Jeffrey W.
AU - Kirtane, Ajay
AU - Parikh, Manish
AU - Ali, Ziad A.
AU - Kalra, Sanjog
AU - Kandzari, David E.
AU - Lembo, Nicholas
AU - Garcia, Santiago
AU - Rangan, Bavana V.
AU - Thompson, Craig A.
AU - Banerjee, Subhash
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Dr. Jaffer: consultant to Boston Scientific, Siemens, and Merck, nonfinancial research support from Abbott Vascular, research grant from National Institutes of Health (HL-R01-108229).
Funding Information:
Study data were collected and managed using REDCap electronic data capture tools hosted at University of Texas Southwestern Medical Center.2 REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources.
Funding Information:
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) — a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42 (2):377-81. REDCap is supported by CTSA NIH Grant UL1-RR024982 . REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources.
Funding Information:
Dr. Grantham: Speaking fees, consulting, and honoraria from Boston Scientific, Asahi Intecc. Research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, Medtronic.
Funding Information:
Dr. Banerjee: research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR). Methods We examined outcomes of ADR among 1313 CTO PCIs performed at 11 US centers between 2012-2015. Results 84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9%). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8 ± 1.2 vs. 2.4 ± 1.2, p < 0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p = 0.005) and procedural success (85.0% vs. 90.7%, p = 0.002), but similar risk for MACE (2.9% vs. 2.2%, p = 0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p < 0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p = 0.43), procedural success (91.8% vs. 94.1%, p = 0.23), and MACE (2.1% vs. 0.6%, p = 0.12). Conclusions ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.
AB - Background We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR). Methods We examined outcomes of ADR among 1313 CTO PCIs performed at 11 US centers between 2012-2015. Results 84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9%). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8 ± 1.2 vs. 2.4 ± 1.2, p < 0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p = 0.005) and procedural success (85.0% vs. 90.7%, p = 0.002), but similar risk for MACE (2.9% vs. 2.2%, p = 0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p < 0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p = 0.43), procedural success (91.8% vs. 94.1%, p = 0.23), and MACE (2.1% vs. 0.6%, p = 0.12). Conclusions ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.
KW - Chronic total occlusion
KW - Complications
KW - Dissection and re-entry
KW - Outcomes
KW - Techniques
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U2 - 10.1016/j.ijcard.2016.03.215
DO - 10.1016/j.ijcard.2016.03.215
M3 - Article
C2 - 27088405
AN - SCOPUS:84963733992
SN - 0167-5273
VL - 214
SP - 428
EP - 437
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -