title: Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry.
abstract: BACKGROUND
  We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR).
  
  
  METHODS
  We examined outcomes of ADR among 1313 CTO PCIs performed at 11 US centers between 2012-2015.
  
  
  RESULTS
  84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9%). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8±1.2 vs. 2.4±1.2, p<0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p=0.005) and procedural success (85.0% vs. 90.7%, p=0.002), but similar risk for MACE (2.9% vs. 2.2%, p=0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p<0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p=0.43), procedural success (91.8% vs. 94.1%, p=0.23), and MACE (2.1% vs. 0.6%, p=0.12).
  
  
  CONCLUSIONS
  ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Barbara Anna
authors.initials: BA
authors.lastname: Danek
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, CA, United States.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, CA, United States.
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Torrance Memorial Medical Center, Torrance, CA, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Wyman
authors.affiliation: Mid America Heart Institute, Kansas City, MO, United States.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Medical Center of the Rockies, Loveland, CO, United States.
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.affiliation: Columbia University, New York, NY, United States.
authors.forename: Sanjog
authors.initials: S
authors.lastname: Kalra
authors.affiliation: Piedmont Heart Institute, Atlanta, GA, United States.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Piedmont Heart Institute, Atlanta, GA, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN, United States.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Boston Scientific, Natick, MA, United States.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D054059:Coronary Occlusion / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Chronic total occlusion; Complications; Dissection and re-entry; Outcomes; Techniques