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Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary
Deniz Mutlu1, Dimitrios Strepkos1,2, Ozgur Selim Ser1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Dual lumen microcatheter (DLMC)-assisted parallel wiring improves technical success in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) when antegrade wiring fails. This method does not increase the risk of major adverse cardiac events (MACE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains challenging.
- The effectiveness and safety of dual lumen microcatheter (DLMC)-assisted parallel wiring compared to traditional methods are not well-established.
- Limited studies exist on DLMC-assisted parallel wiring in CTO PCI.
Purpose of the Study:
- To compare the outcomes of traditional versus DLMC-assisted parallel wiring in CTO PCI.
- To evaluate technical success and safety profiles of both wiring techniques.
- To analyze clinical and angiographic characteristics in a large, multicenter registry.
Main Methods:
- A multicenter registry of 1353 CTO PCIs with failed antegrade wiring (AW) was analyzed.
- Patients were divided into traditional parallel wiring (n=1081) and DLMC-assisted parallel wiring (n=272) groups.
- Propensity score matching was used to compare outcomes, including technical success and major adverse cardiac events (MACE).
Main Results:
- DLMC-assisted wiring was used in more complex lesions (higher J-CTO score, ambiguous proximal cap, calcification).
- Technical success was significantly higher in the DLMC group (87.1% vs. 74.3%, p<0.001).
- After propensity score matching, DLMC-assisted wiring showed higher technical success (OR 2.17, p=0.002) without a significant increase in MACE (OR 2.00, p=0.093).
Conclusions:
- In CTO PCI cases where AW fails, DLMC-assisted parallel wiring is associated with a higher likelihood of technical success.
- DLMC-assisted parallel wiring does not appear to increase the risk of MACE compared to traditional parallel wiring.
- DLMC-assisted parallel wiring is a valuable technique for complex CTO lesions.
Background:
The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
Aims:
To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.
Methods:
We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.
Results:
Among 1353 CTO PCIs with failed AW with a single wire, traditional parallel wiring (n = 1081) or DLMC-assisted parallel wiring (n = 272) were utilized at the operator's discretion. The baseline characteristics of patients were similar in both groups except for higher prevalence of diabetes mellitus, and lower prevalence of hypertension, prior heart failure, prior MI and cerebrovascular disease in DLMC patients. Lesions in the DLMC group were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate/severe calcification, and had higher J-CTO score (2.6 ± 1.0 vs. 2.1 ± 1.3, p < 0.001). Technical (87.1% vs. 74.3%, p < 0.001) and procedural (83.8% vs. 75.5%, p = 0.001) success and the incidence of in-hospital major cardiac adverse events (MACE) (4.8% vs. 2.0%, p = 0.020) were higher in the DLMC group. In propensity score matching analysis, DLMC-assisted wiring was associated with higher technical success (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.54, p = 0.002) and no significant difference in MACE (OR 2.00, 95% CI 0.89-4.50, p = 0.093).
Conclusions:
In lesions that could not be crossed with AW, DLMC-assisted parallel wiring was associated with a higher likelihood of technical success, without an increased risk of MACE, compared with traditional parallel wiring.
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