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Multicenter experience with the antegrade fenestration and reentry technique for chronic total occlusion
Lorenzo Azzalini1,2, Khaldoon Alaswad3, Barry F Uretsky4
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Antegrade fenestration and reentry (AFR) shows moderate success for chronic total occlusion (CTO) recanalization. This technique is safe and does not prevent alternative methods if initial attempts fail.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Biology
Background:
- Antegrade dissection/reentry (ADR) adoption for chronic total occlusion (CTO) recanalization is limited.
- Novel ADR techniques are needed to improve CTO recanalization rates.
- Antegrade fenestration and reentry (AFR) is a novel ADR technique.
Purpose of the Study:
- To evaluate the efficacy and safety of antegrade fenestration and reentry (AFR) for CTO recanalization.
- To assess AFR success, procedural success, and target-lesion failure (TLF) in a multicenter registry.
- To determine the feasibility of AFR in complex CTO cases.
Main Methods:
- A multicenter registry included patients undergoing AFR-based CTO recanalization.
- AFR involves creating fenestrations between false and true lumens, followed by guidewire reentry.
- Study endpoints included AFR success, procedural success, and 1-year TLF.
Main Results:
- AFR achieved distal true lumen reentry in 65.9% of cases.
- Overall technical and procedural success rates were 85.4% and 82.9%, respectively.
- No AFR-related complications were observed; 1-year TLF was 8.3%.
Conclusions:
- AFR demonstrates feasibility and a moderate success rate for CTO recanalization.
- The technique is safe, and failed attempts do not preclude alternative recanalization strategies.
- Further studies are warranted to confirm and extend these findings.
Objectives:
We aimed to evaluate the efficacy and safety of antegrade fenestration and reentry (AFR) for chronic total occlusion (CTO) recanalization in a multicenter registry.
Background:
Adoption of antegrade dissection/reentry (ADR) for CTO recanalization has been limited, and novel ADR techniques are needed.
Methods:
AFR involves the balloon-induced creation of multiple fenestrations between the false and true lumen. A targeted true lumen reentry is subsequently achieved with a low tip-load polymer-jacketed guidewire. Following the initial description and dissemination of AFR, patients undergoing AFR-based CTO recanalization at nine centers were included in the present registry. Study endpoints were AFR success, procedural success, and target-lesion failure (TLF) on follow-up.
Results:
We included 41 patients. Mean J-CTO score was 2.5 ± 1.4. In 80.5% of cases, AFR was performed after failed antegrade wire escalation. Another ADR technique was used before AFR in one-third of cases. AFR achieved distal true lumen reentry in n = 27/41 (65.9%) cases. In n = 14/41 (34.1%) cases with AFR failure, use of alternative techniques led to successful CTO recanalization in eight additional patients. The overall technical and procedural success rates were 85.4% and 82.9%, respectively. No AFR-related complications were observed. One-year TLF rate was 8.3% overall, with no differences between successful and failed AFR.
Conclusions:
We report on AFR feasibility in a multicenter registry of patients undergoing CTO recanalization. We observed a moderate success rate, coupled with the absence of complications. Moreover, even a failed AFR attempt did not preclude the use of alternative techniques to achieve recanalization. Further studies should confirm and extend our findings.
