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A Novel Parallel Wire-based Antegrade Dissection Re-entry Technique for Failed Retrograde Attempt of Coronary Chronic
Yuanji Ma1,2,3, Hao Lu1,2,3, Yiqing Hu1,2,3
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
A new hybrid technique, parallel wire-based antegrade dissection re-entry (PW-ADR), successfully treats complex coronary chronic total occlusions (CTO) when other methods fail. A risk score helps predict potential technical failures in these challenging CTO interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary chronic total occlusion (CTO) interventions have advanced, improving success rates.
- Antegrade dissection re-entry (ADR) is key for long CTOs but can fail, especially with poor collaterals.
- The retrograde approach may also be unsuccessful in complex CTO cases.
Purpose of the Study:
- To evaluate the efficacy of a novel hybrid algorithm, parallel wire-based ADR (PW-ADR), for CTO interventions.
- To assess the success rate and safety of PW-ADR in patients with failed retrograde approaches.
- To develop a risk nomogram for predicting technical failure in PW-ADR procedures.
Main Methods:
- A retrospective analysis of 57 patients undergoing PW-ADR at a single center.
- PW-ADR combines parallel wire technique (PWT) with device-based ADR for complex CTOs.
- A risk nomogram was developed using predictor variables for technical failure.
Main Results:
- PW-ADR achieved technical and procedural success in 80.7% of cases (46/57).
- Low rates of in-hospital complications and 1-year major adverse cardiac events (MACE) were observed.
- The risk nomogram, incorporating vessel tortuosity, J-CTO score, and antegrade coronary angiography (CAG) times, showed high accuracy (AUROC 0.947) in predicting technical failure.
Conclusions:
- The hybrid PW-ADR technique offers a promising alternative for complex CTO interventions.
- The developed risk nomogram can identify high-risk patients, potentially guiding treatment strategy adjustments.
- PW-ADR demonstrates a favorable success rate and safety profile for challenging CTO lesions.
Background:
Rapid development in coronary chronic total occlusion (CTO) interventional techniques and devices have achieved a greater success rate with favorable outcomes. Antegrade dissection re-entry (ADR) technique is an important CTO crossing strategy and a desirable approach for long CTOs with good distal landing zone. However, unsuccessful procedures in contemporary CTO-percutaneous coronary intervention (PCI) remain, especially in lesions with non-interventional collaterals.
Method:
Based on a single center experience, a hybrid interventional algorithm, parallel wire-based ADR (PW-ADR) combines the advantages of parallel wire technique (PWT) and device-based ADR to target CTO lesions with failed retrograde approach. A retrospective analysis of patients who underwent PW-ADR was performed. A risk nomogram was created to identify patients at high risk for technical failure.
Results:
A total of 57 patients treated with PW-ADR were ultimately included in the present study. A total of 46 (80.7%) cases achieved technical success and procedural success, with low incidence of in-hospital complications or 1-year major adverse cardiac events (MACE). The risk nomogram identified 3 predictor variables associated with technical failure of PW-ADR, including tortuous vessel, J-CTO score, and times of antegrade coronary angiography (CAG) during ADR, with promising accuracy (AUROC 0.947).
Conclusion:
The novel hybrid CTO-PCI algorithm, PW-ADR, provided an alternative interventional approach for complex CTO lesions with a promising success rate. The risk nomogram served as a prompter for high-risk cases, which may warrant a change in treatment strategy.
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