Lorenzo Azzalini1, Rustem Dautov2, Emmanouil S Brilakis3, Soledad Ojeda4, Susanna Benincasa1, Barbara Bellini1, Aris Karatasakis5, Jorge Chavarría4, Bavana V Rangan5, Manuel Pan4, Mauro Carlino1, Antonio Colombo1, Stéphane Rinfret6. 1. Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy. 2. Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada; Interventional Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada. 3. Interventional Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA. 4. Interventional Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain. 5. VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. 6. Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada; Interventional Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada. Electronic address: stephane.rinfret@mcgill.ca.
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.
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.
Authors: Stefan P Schumacher; Roel S Driessen; Wijnand J Stuijfzand; Pieter G Raijmakers; Ibrahim Danad; Jo Dens; James C Spratt; Colm G Hanratty; Simon J Walsh; Ronald Boellaard; Albert C van Rossum; Maksymilian P Opolski; Alexander Nap; Paul Knaapen Journal: Catheter Cardiovasc Interv Date: 2018-11-15 Impact factor: 2.692