TY - JOUR
T1 - Use of the Limited Antegrade Subintimal Tracking Technique in Chronic Total Occlusion Percutaneous Coronary Intervention
AU - Karacsonyi, Judit
AU - Kostantinis, Spyridon
AU - Simsek, Bahadir
AU - Alaswad, Khaldoon
AU - Karmpaliotis, Dimitri
AU - Kirtane, Ajay
AU - Jaffer, Farouc
AU - Choi, James W.
AU - Koutouzis, Michalis
AU - Tsiafoutis, Ioannis
AU - Kandzari, David E.
AU - Poommipanit, Paul
AU - Khatri, Jaikirshan J.
AU - Elbarouni, Basem
AU - Gorgulu, Sevket
AU - ElGuindy, Ahmed
AU - Abi Rafeh, Nidal
AU - Goktekin, Omer
AU - Ungi, Imre
AU - Rangan, Bavana Venkata
AU - Sandoval, Yader
AU - Allana, Salman
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Study data were collected and managed using REDCap electronic data capture tools hosted at the Minneapolis Heart Institute Foundation. REDCap 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.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/11/28
Y1 - 2022/11/28
N2 - Background: There are limited data on the limited antegrade subintimal tracking (LAST) technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Objectives: The aim of this study was to analyze the frequency of use and outcomes of the LAST technique for CTO PCI. Methods: We analyzed 2,177 CTO PCIs performed using antegrade dissection and re-entry (ADR) in the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) registry between 2012 and January 2022 at 39 centers. ADR was attempted in 1,465 cases (67.3%). Results: Among antegrade re-entry cases, LAST was used in 163 (11.1%) (primary LAST in 127 [8.7%] and secondary LAST [LAST after other ADR approaches failed] in 36 [2.5%]), the Stingray system (Boston Scientific) in 980 (66.9%), subintimal tracking and re-entry in 387 (26.4%), and contrast-guided subintimal tracking and re-entry in 29 (2.0%). The mean patient age was 65.2 ± 10 years, and 85.8% were men. There was no significant difference in technical (71.8% vs 77.8%; P = 0.080) and procedural (69.9% vs 75.3%; P = 0.127) success and major cardiac adverse events (1.84% vs 3.53%; P = 0.254) between LAST and non-LAST cases. However, on multivariable analysis, the use of LAST was associated with lower procedural success (OR: 0.61; 95% CI: 0.41-0.91). Primary LAST was associated with higher technical (76.4% vs 55.6%; P = 0.014) and procedural (75.6% vs 50.0%; P = 0.003) success and similar major adverse cardiac event (1.57% vs 2.78%; P = 0.636) rates compared with secondary LAST. Conclusions: LAST was used in 11.1% of antegrade re-entry CTO PCI cases and was associated with lower procedural success on multivariable analysis, suggesting a limited role of LAST in contemporary CTO PCI.
AB - Background: There are limited data on the limited antegrade subintimal tracking (LAST) technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Objectives: The aim of this study was to analyze the frequency of use and outcomes of the LAST technique for CTO PCI. Methods: We analyzed 2,177 CTO PCIs performed using antegrade dissection and re-entry (ADR) in the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) registry between 2012 and January 2022 at 39 centers. ADR was attempted in 1,465 cases (67.3%). Results: Among antegrade re-entry cases, LAST was used in 163 (11.1%) (primary LAST in 127 [8.7%] and secondary LAST [LAST after other ADR approaches failed] in 36 [2.5%]), the Stingray system (Boston Scientific) in 980 (66.9%), subintimal tracking and re-entry in 387 (26.4%), and contrast-guided subintimal tracking and re-entry in 29 (2.0%). The mean patient age was 65.2 ± 10 years, and 85.8% were men. There was no significant difference in technical (71.8% vs 77.8%; P = 0.080) and procedural (69.9% vs 75.3%; P = 0.127) success and major cardiac adverse events (1.84% vs 3.53%; P = 0.254) between LAST and non-LAST cases. However, on multivariable analysis, the use of LAST was associated with lower procedural success (OR: 0.61; 95% CI: 0.41-0.91). Primary LAST was associated with higher technical (76.4% vs 55.6%; P = 0.014) and procedural (75.6% vs 50.0%; P = 0.003) success and similar major adverse cardiac event (1.57% vs 2.78%; P = 0.636) rates compared with secondary LAST. Conclusions: LAST was used in 11.1% of antegrade re-entry CTO PCI cases and was associated with lower procedural success on multivariable analysis, suggesting a limited role of LAST in contemporary CTO PCI.
KW - chronic total occlusion
KW - limited antegrade subintimal tracking
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jcin.2022.08.052
DO - 10.1016/j.jcin.2022.08.052
M3 - Article
C2 - 36423972
AN - SCOPUS:85141785332
SN - 1936-8798
VL - 15
SP - 2284
EP - 2293
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 22
ER -