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Exploring indicators of success in chronic total occlusion percutaneous coronary intervention with Stingray
Insights
Predictors for successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using Stingray antegrade dissection and re-entry (ADR) were identified. Vessel calcification and retrograde puncture indicate success, while stump type and procedure timing are negative predictors.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Predictors for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) success using the Stingray antegrade dissection and re-entry (ADR) technique are not well-established.
- Lack of consecutive angiographic and procedural data has hindered understanding of Stingray ADR success factors.
Purpose of the Study:
- To identify indicators that predict the success of CTO PCI performed with the Stingray ADR technique.
Main Methods:
- Retrospective analysis of clinical data from 115 patients undergoing CTO PCI via Stingray ADR.
- Multivariate logistic regression was employed to determine independent predictors of ADR success.
Main Results:
- The technical success rate for Stingray ADR in CTO PCI was 72.2%.
- Vessel calcification (OR: 4.03) and retrograde puncture (OR: 4.89) were positive predictors of success.
- Blunt/no stump (OR: 0.22), longer decision time (OR: 0.54), longer operation duration (OR: 0.62), and intraplaque puncture (OR: 0.24) were negative predictors.
Conclusions:
- Vessel calcification and retrograde puncture facilitate successful Stingray ADR.
- Prompt initiation, efficient operation, and distal cap puncture under retrograde guidance improve Stingray ADR success rates.
Background:
The predictors of success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) through antegrade dissection and re-entry (ADR) using the Stingray system (Stingray ADR) remain elusive, mainly owing to the lack of consecutive angiographic and procedural records of patients.
Objectives:
This study aimed to identify indicators that can determine the success of CTO PCI performed using the Stingray ADR technique.
Methods:
The clinical data of 115 patients who underwent CTO PCI through Stingray ADR at the same cardiac center were retrospectively and consecutively collected. Multivariate logistic regression analysis was performed to investigate the indicators of the success of ADR attempts.
Results:
The technical success rate of Stingray ADR in CTO PCI was 72.2%. The overall technical success rate of CTO recanalization was 78.3% in all CTO PCIs having used Stingray Low Profile balloon. Vessel calcification (odds ratio [OR]: 4.03; 95% confidence interval [CI]: 1.49-11.88; p = 0.008), and retrograde puncture indicator (OR: 4.89; 95% CI: 1.51-17.11; p = 0.009) were identified as independent positive predictors. Blunt/no stump proximal to the occlusion segment (OR: 0.22; 95% CI: 0.06-0.64; p = 0.009), decision time before Stingray ADR (per 1 h increase) (OR: 0.54; 95% CI: 0.31-0.92; p = 0.026), operation duration of Stingray ADR (per 10 min increase) (OR: 0.62; 95% CI: 0.40-0.94; p = 0.028), and puncture site at the intraplaque region (OR: 0.24; 95% CI: 0.06-0.84; p = 0.026) were identified as the four negative independent predictors.
Conclusions:
This study revealed independent predictors of the success of CTO PCI performed using the Stingray ADR technique. As for CTO characteristics, the presence of calcification in the CTO segment and a tapered stump proximal to the lesion site can facilitate successful Stingray ADR. As for the procedures, the success rate of Stingray ADR can be improved by initiating the technique decisively and promptly, operating the system quickly and accurately and creating a puncture in the distal cap region of CTO under retrograde guidance.
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