Subintimal guidewire tracking during successful percutaneous therapy for chronic coronary total occlusions: insights
Kamran I Muhammad1, William L Lombardi, Ryan Christofferson
1Cleveland Clinic, Cleveland, Ohio 44195, USA.
Insights
Subintimal guidewire tracking occurs in nearly half of successful percutaneous coronary intervention (PCI) procedures for chronic total occlusions (CTOs). This finding indicates increased lesion complexity and longer procedure times during CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) improves outcomes in ischemic patients.
- Subintimal guidewire tracking is a known cause of failure in CTO PCI, but its implications in successful procedures are unclear.
Purpose of the Study:
- To determine the frequency of subintimal guidewire tracking during successful CTO PCI.
- To understand the procedural implications of subintimal guidewire tracking in successful CTO PCI.
Main Methods:
- Analysis of 26 consecutive patients with successfully crossed de-novo CTO lesions.
- Intravascular ultrasound (IVUS) used to classify cases with definite subintimal wire tracking.
- Comparison of procedural characteristics between groups with and without subintimal wire tracking.
Main Results:
- Subintimal wire tracking was observed in 45% of successful CTO PCI cases.
- Subintimal tracking was associated with prior failed attempts (42% vs. 7%).
- Increased procedure time, fluoroscopy time, contrast dose, and stent length were noted in the subintimal tracking group.
Conclusions:
- Subintimal guidewire tracking is a frequent event during successful CTO PCI.
- The presence of subintimal tracking signifies greater lesion and procedural complexity.
Objectives:
We sought to determine the frequency of subintimal guidewire tracking during successful percutaneous coronary intervention (PCI) for chronic coronary total occlusions (CTOs) and to better understand the procedural implications of this event.
Background:
Successful PCI for chronic CTO is associated with improved outcomes in patients with ischemia. While subintimal guidewire tracking resulting in failure to cross is recognized as the major mode of failure for CTO PCI, the implications of subintimal guidewire tracking during successful CTO PCI are unknown.
Methods:
Between March 2007 and October 2007, 26 consecutive patients, each with one de-novo CTO lesion successfully crossed with a guidewire were included in the analysis. Intravascular ultrasound (IVUS) was performed in each CTO vessel after guidewire crossing. Cases were classified as having definite subintimal wire tracking or no clear evidence of subintimal wire tracking based on analysis of IVUS images.
Results:
Subintimal wire tracking occurred in 45% of cases. In cases where subintimal wire tracking was present, a previous attempt at CTO PCI was more common (42% vs. 7%, P ≤ 0.05). Subintimal wire tracking was also associated with significantly longer final mean stent length (71 vs. 50 mm), procedure time (122 vs. 69 min), fluoroscopy time (47 vs. 22 min), and contrast dose (300 vs. 199 mL, P ≤ 0.05 for all). There was one perforation in the subintimal group which was successfully treated with stent placement.
Conclusions:
Subintimal wire tracking occurs frequently during successful PCI for CTO and is associated with increased lesion and procedural complexity.
