Dissection Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention

Area of Science:

• Interventional Cardiology
• Vascular Medicine
• Medical Devices

Background:

• Limited data exists on dissection strategies for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
• Understanding these strategies is crucial for improving procedural outcomes.

Purpose of the Study:

• To compare baseline characteristics and procedural outcomes of antegrade CTO PCI using different dissection strategies.
• To evaluate the effectiveness of knuckle wiring, CrossBoss catheter, and Carlino technique.

Main Methods:

• Comparative analysis of antegrade dissection and re-entry CTO PCI from the PROGRESS-CTO registry (2012-2024).
• Three strategies compared: knuckle wiring, CrossBoss catheter technique, and Carlino technique.
• Exclusion of in-stent CTO PCI cases.

Main Results:

• Knuckle wiring was the most frequent strategy (74.6%), with increasing utilization over time.
• CrossBoss technique (20.2%) was used in less complex lesions (lower J-CTO scores) and showed higher technical success (84.0%) and lower perforation rates.
• Carlino technique (5.2%) was associated with longer crossing times (133 min).

Conclusions:

• Knuckle wiring is the predominant antegrade dissection strategy for CTO PCI.
• The CrossBoss catheter is associated with higher success in less complex cases, while the Carlino technique is used for more complex lesions.