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Outcomes of contemporary versus conventional reverse controlled and antegrade and retrograde subintimal tracking in
Rende Xu1, Yuekai Shi1, Shufu Chang1
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Contemporary reverse CART offers improved efficiency and fewer complications for chronic total occlusion percutaneous coronary intervention (PCI) compared to conventional techniques. Both methods demonstrate similar success rates and long-term clinical outcomes in CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) presents significant technical challenges.
- The retrograde approach, particularly reverse controlled anterograde and retrograde sub-intimal tracking (reverse CART), has improved CTO recanalization success rates.
- Reverse CART techniques are categorized as conventional, contemporary, and extended.
Purpose of the Study:
- To compare the safety and efficacy of conventional and contemporary reverse CART techniques in CTO PCI.
- To evaluate procedural outcomes and clinical events associated with each technique.
Main Methods:
- A retrospective study included 303 patients undergoing successful retrograde guidewire crossing using conventional or contemporary reverse CART for CTO PCI.
- Patient characteristics, procedural outcomes, and in-hospital and 1-year clinical events were compared between the two groups.
- Data were collected from March 2015 to May 2020.
Main Results:
- Baseline and angiographic characteristics were similar, though CTO lesions in the conventional group were more complex (higher J-CTO scores).
- Contemporary reverse CART was linked to shorter procedure times (181.7 vs. 189.8 min) and fewer complications, including target vessel perforation (0.6% vs. 3.6%) and major side-branch occlusion (28.0% vs. 36.7%).
- Technical success, procedural success, and 1-year clinical outcomes did not differ significantly between the groups.
Conclusions:
- Contemporary reverse CART demonstrates high efficiency and low complication rates in CTO PCI.
- It offers comparable success rates and 1-year clinical outcomes to conventional reverse CART.
- The contemporary technique is a safe and effective alternative for CTO recanalization.
Background:
Chronic total occlusion (CTO) lesions remain technically challenging for percutaneous coronary intervention (PCI). The introduction of a retrograde approach has allowed marked improvement in the success rate of CTO recanalization. Reverse controlled anterograde and retrograde sub-intimal tracking (reverse CART) is the predominant retrograde wire crossing technique and can be broadly classified into three categories: (1) conventional (2) contemporary and (3) extended. The present study aimed to compare the safety and efficacy of conventional and contemporary reverse CART techniques.
Methods:
From March 2015 to May 2020, 303 patients achieving successful retrograde guidewire crossing with conventional or contemporary reverse CART during CTO PCI were included in the study. The patient characteristics, procedural outcomes and in-hospital and 1-year clinical events were compared between the conventional and contemporary groups.
Results:
The distributions of the baseline and angiographic characteristics were similar in both study arms, except the CTO lesions of the conventional group were more complex, as reflected by borderline significantly higher mean J-CTO scores (3.4 ± 0.7 vs. 3.3 ± 0.8; p = 0.059). Recanalization using contemporary reverse CART was associated with a short procedure time (189.8 ± 44.4 vs. 181.7 ± 37.3 min; p = 0.044) and decreased procedural complications, particularly target vessel perforation (3.6% vs. 0.6%; p = 0.063) and major side-branch occlusion (36.7% vs. 28.0%; p = 0.051). Technical and procedural success and the in-hospital and 1-year outcomes were not significantly different between the groups.
Conclusions:
Contemporary reverse CART is associated with favorably high efficiency and low-complication rates and carries a comparable success rate and 1-year clinical outcomes as conventional reverse CART.
