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Device-based antegrade dissection re-entry versus parallel wire techniques for the percutaneous revascularization of
Qing Qin1, Shufu Chang2, Rende Xu2
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China. qin.qing@zs-hospital.sh.cn.
Insights
Device-based antegrade dissection re-entry (ADR) and parallel wire technique (PWT) show similar procedural success and mid-term outcomes for chronic total occlusion percutaneous coronary intervention (CTO PCI). ADR involves higher complexity but yields comparable results to PWT in CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) utilizes antegrade techniques like device-based antegrade dissection re-entry (ADR) and parallel wire technique (PWT).
- Comparing the efficacy and safety of these two ADR and PWT approaches is crucial for optimizing CTO PCI procedures.
Purpose of the Study:
- To compare procedural and mid-term outcomes between device-based ADR (CrossBoss/Stingray) and PWT in patients undergoing CTO PCI.
- To evaluate the safety and effectiveness of ADR versus PWT in a real-world clinical setting.
Main Methods:
- Retrospective data collection from patients undergoing CTO PCI using either device-based ADR or PWT.
- Exclusion of CTO cases resulting from in-stent restenosis.
Main Results:
- A total of 273 patients were analyzed (55 in ADR group, 218 in PWT group).
- Despite higher contrast use, intravascular ultrasound guidance, guidewires, and troponin T levels in the ADR group, technical success, procedural success, and in-hospital complications were similar between groups.
- At 1-year follow-up, major adverse cardiac events (MACE) rates were comparable (7.3% vs. 14.7%, p=0.150).
Conclusions:
- Device-based ADR for CTO PCI demonstrates comparable in-hospital safety and mid-term MACE rates to PWT.
- ADR may involve higher procedural complexity but does not compromise clinical outcomes compared to PWT.
Background:
Device-based antegrade dissection re-entry (ADR) and parallel wire technique (PWT) are two important techniques in the antegrade approach in percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). The study is aimed to compare the procedural and mid-term outcomes between device-based ADR using the CrossBoss/Stingray system and PWT in CTO PCI.
Methods:
Data was retrospectively collected from consecutive patients who underwent CTO PCI using device-based ADR or PWT. CTO due to in-stent restenosis were excluded.
Results:
A total of 273 patients were included in the study (n = 55 in device-based ADR group, n = 218 in PWT group). Baseline characteristics were similar across groups except for higher prevalence of prior PCI and lower level of lipid profile in the ADR group. Moreover, although patients in the ADR group showed higher contrast volume (441.6 ± 162.4 mL vs. 361.5 ± 142.1 mL, p < 0.001), more intravascular ultrasound guidance (50.9% vs. 22.9%, p < 0.001), more guidewires used (4.6 ± 1.4 vs. 3.4 ± 1.2, p < 0.001) and higher troponin T level after PCI (0.167 vs. 0.087, p = 0.004), the technical success, procedural success and in-hospital complications were similar between the two groups. During a median follow-up of 1 year, the ADR group showed no difference in major adverse cardiac events (MACE, including all cause death, nonfatal myocardial infarction, and ischemia driven target vessel revascularization) (7.3% vs. 14.7%, p = 0.150) as compared with the PWT group.
Conclusions:
In the documented center, the use of device-based ADR for CTO PCI showed no difference in in-hospital complications and mid-term MACE as compared with PWT, despite higher procedure complexity in ADR group.
