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Reclassification of CTO Crossing Strategies in the ERCTO Registry According to the CTO-ARC Consensus Recommendations
Giuseppe Vadalà1, Kambis Mashayekhi2, Marouane Boukhris3
1Division of Cardiology, University Hospital P. Giaccone, Palermo, Italy.
Insights
The study standardized chronic total occlusion (CTO) percutaneous coronary intervention (PCI) definitions. Alternative antegrade crossing strategies showed lower success and higher complication rates compared to true antegrade and retrograde approaches.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Research
Background:
- A nonstandardized definition of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) approaches can bias complication attribution.
- The Chronic Total Occlusion Academic Research Consortium (CTO-ARC) identified the need for standardized definitions.
Purpose of the Study:
- To describe the numbers, efficacy, and safety of each final CTO crossing strategy.
- To apply CTO-ARC recommendations for classifying CTO PCI procedures.
Main Methods:
- Cross-sectional study utilizing data from the European Registry of Chronic Total Occlusions (2021-2022).
- Analysis of 8,673 patient cases categorized by antegrade and retrograde CTO crossing strategies.
Main Results:
- Antegrade approaches were used in 79.2% of cases, retrograde in 20.8%.
- Alternative antegrade crossing, often a rescue strategy (96.1%), had lower technical success (70%) and higher complication rates (4.6%) compared to true antegrade and retrograde crossing.
- CTO-ARC definitions reclassified 6.7% of procedures as alternative antegrade crossing.
Conclusions:
- Applying CTO-ARC definitions improved procedural classification.
- Alternative antegrade CTO PCI strategies are associated with increased major adverse cardiovascular and cerebrovascular events (MACCE) and reduced technical success rates compared to true antegrade and retrograde methods.
Background:
The CTO-ARC (Chronic Total Occlusion Academic Research Consortium) recognized that a nonstandardized definition of chronic total occlusion (CTO) percutaneous coronary intervention approaches can bias the complications' attribution to each crossing strategy.
Objectives:
The study sought to describe the numbers, efficacy, and safety of each final CTO crossing strategy according to CTO-ARC recommendations.
Methods:
In this cross-sectional study, data were retrieved from the European Registry of Chronic Total Occlusions between 2021 and 2022.
Results:
Out of 8,673 patients, antegrade and retrograde approach were performed in 79.2% and 20.8% of cases, respectively. The antegrade approach included antegrade wiring and antegrade dissection and re-entry, both performed with or without retrograde contribution (antegrade wiring without retrograde contribution: n = 5,929 [68.4%]; antegrade wiring with retrograde contribution: n = 446 [5.1%]; antegrade dissection and re-entry without retrograde contribution: n = 353 [4.1%]; antegrade dissection and re-entry with retrograde contribution: n = 137 [1.6%]). The retrograde approach included retrograde wiring (n = 735 [8.4%]) and retrograde dissection and re-entry (n = 1,073 [12.4%]). Alternative antegrade crossing was associated with lower technical success (70% vs 86% vs 93.1%, respectively; P < 0.001) and higher complication rates (4.6% vs 2.9% vs 1%, respectively; P < 0.001) as compared with retrograde and true antegrade crossing. However, alternative antegrade crossing was applied mostly as a rescue strategy (96.1%).
Conclusions:
The application of CTO-ARC definitions allowed the reclassification of 6.7% of procedures as alternative antegrade crossing with retrograde or antegrade contribution which showed higher MACCE and lower technical success rates, as compared with true antegrade and retrograde crossing.
