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Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total

Kei Yamamoto1, Kenichi Sakakura1, Takunori Tsukui1

  • 1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Plos One
|April 25, 2020
PubMed

Insights

The rare antegrade true-sub-true phenomenon in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can lead to successful outcomes. This phenomenon is significantly associated with CTO exit-sites featuring abrupt bifurcations.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) success rates are improving.
  • The antegrade wire-based approach typically requires dissection re-entry devices for guidewire advancement.
  • Intravascular ultrasound (IVUS) sometimes reveals guidewires advancing from the subintimal to the intimal space without such devices, termed the 'antegrade true-sub-true' phenomenon.

Purpose of the Study:

  • To investigate the specific conditions and characteristics associated with the 'antegrade true-sub-true' phenomenon during CTO-PCI.

Main Methods:

  • Retrospective review of 320 CTO lesions undergoing CTO-PCI.
  • Categorization into a 'true-sub-true' group (16 lesions with IVUS-confirmed phenomenon) and an 'unsuccessful' group (27 lesions).
  • Comparison of clinical, lesion, and procedural characteristics between the two groups.

Main Results:

  • The 'true-sub-true' group showed a significantly higher prevalence of bifurcation with abrupt type at CTO exit-sites compared to the unsuccessful group (75.0% vs. 25.9%, p = 0.002).
  • Multivariate logistic regression identified bifurcation with abrupt type at the CTO exit-site as an independent predictor (OR 8.017; 95% CI: 1.484-43.304; p = 0.016).

Conclusions:

  • The antegrade true-sub-true phenomenon in CTO-PCI is rare but offers a potential pathway for successful intervention.
  • Bifurcation with an abrupt type at the CTO exit-site is significantly associated with this phenomenon.
Abstract

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