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A Technical Focus on Antegrade Dissection and Re-entry for Coronary Chronic Total Occlusions: a Practice Update for

Simon J Walsh1, Claudia Cosgrove2, James C Spratt2

  • 1Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, United Kingdom. simon.j.walsh@btinternet.com.

Korean Circulation Journal
|June 28, 2019
PubMed

Insights

Antegrade dissection and re-entry (ADR) is a key technique for treating complex coronary chronic total occlusions (CTOs). Understanding ADR and other approaches is crucial for successful percutaneous coronary intervention.

Area of Science:

  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Coronary chronic total occlusions (CTOs) are common, presenting diverse patient anatomy.
  • High technical success rates (~90%) are achievable with expertise, often using wire-based techniques.

Purpose of the Study:

  • To provide an overview of the antegrade dissection and re-entry (ADR) technique.
  • To discuss updated approaches in contemporary clinical practice for CTO percutaneous coronary intervention.

Main Methods:

  • Review of advanced techniques for CTO lesions, including retrograde access and blunt dissection.
  • Focus on antegrade dissection and re-entry (ADR) and retrograde dissection and re-entry (RDR) strategies.
  • Discussion of risk-benefit considerations when both ADR and RDR are feasible.

Main Results:

  • Anatomically complex CTO lesions often necessitate advanced approaches beyond simple wire techniques.
  • ADR can be a safe and efficient method for crossing CTO lesions.
  • Operator awareness of differing technical approaches is vital for successful CTO PCI.

Conclusions:

  • ADR is a valuable strategy for navigating challenging CTO segments.
  • Contemporary practice emphasizes a comprehensive understanding of various CTO intervention techniques.
  • Optimal patient outcomes depend on judicious selection and application of interventional strategies.

Keywords:
Antegrade dissection and re-entryChronic total occlusionPercutaneous coronary intervention

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