Reclassification of CTO Crossing Strategies in the ERCTO Registry According to the CTO-ARC Consensus Recommendations.

Autor:	Vadalà G; Division of Cardiology, University Hospital P. Giaccone, Palermo, Italy., Mashayekhi K; Department of Cardiology and Angiology, University Heart Center, University of Freiburg, Freiburg, Germany; Department of Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany., Boukhris M; Department of Cardiology, Centre Hospitalier Universitaire Dupuytren, Limoges, France., Behnes M; First Department of Medicine, University Medical Centre Mannheim, Manheim, Germany., Pyxaras S; Medizinische Klinik I, Klinikum Fürth, Academic Teaching Hospital of the Friedrich Alexander University Erlangen-Nürnberg, Fürth, Germany., Christiansen EH; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Gutiérrez-Chico JL; Alfonso X El Sabio University, Madrid, Spain., Maniscalco L; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy., Stojkovic S; Faculty of Medicine, University of Belgrade, Clinic for Cardiology, University Clinical of Serbia, Belgrade, Serbia., Bozinovic NZ; University Clinical Niš, Niš, Serbia., Boudou N; Clinique Saint Augustin, Bordeaux, France., Garbo R; Maria Pia Hospital, GVM Care & Research, Turin, Italy., Werner GS; Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany., Avran A; Centre Hospitalier Valenciennes, Lyon, France., Gasparini GL; Humanitas Research Hospital, IRCSS Rozzano, Milan, Italy., La Scala E; Polyclinique Les Fleurs, Ollioules, France., Ladwiniec A; Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom., Sianos G; AHEPA University Hospital, Thessaloniki, Greece., Goktekin O; Memorial Bahçelievler Hospital, Istanbul, Turkey., Gorgulu S; Biruni University School of Medicine, Istanbul, Turkey., Agostoni P; Hartcentrum, Ziekenhuis Netwerk Antwerpen-Middelheim, Antwerp, Belgium., Rathore S; Frimley Park Hospital NHS Foundation Trust, Camberley, United Kingdom., Ayoub M; University Heart Center NRW, Bad Oeynhausen, Germany., Diletti R; San Giovanni Bosco Hospital, ASL Città Torino, Turin, Italy., di Mario C; Structural Interventional Cardiology Division, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy., Bulum J; University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia., Galassi AR; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy. Electronic address: alfredo.galassi@unipa.it.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2024 Oct 28; Vol. 17 (20), pp. 2425-2437.
DOI:	10.1016/j.jcin.2024.09.002
Abstrakt:	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. Competing Interests: Funding Support and Author Disclosures Dr Bufe has received speaker honoraria from Biotronik and Shockwave Medical. Dr Pyxaras has received consulting/speaker/proctorship honoraria from Abiomed, AstraZeneca, Asahi Intecc, Biotronik, Boston Scientific, and Terumo. Dr Ladwiniec has received consulting/speaker/proctoring honoraria from Abbott, Biotronik, Boston Scientific, Cordis, Shockwave Medical, and SMT. Dr Werner has received speaker honoraria from Abbott, Asahi Intecc, OrbusNeich, Philips, Siemens, and Terumo. Dr Mashayekhi has received consulting/speaker/proctoring honoraria from Abbott, Abiomed, Asahi Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi-Sankyo, Medtronic, OrbusNeich, Shockwave Medical, Teleflex, and Terumo. Dr Ayoub has received consultant/proctor honoraria from Boston Scientific, Teleflex, Asahi Intecc, Cordis, Terumo, and SIS Medical. Dr Goktekin has received consulting/speaker/proctoring honoraria from Boston Scientific, Medtronik, MicroPort, and Asahi Inc. Dr Agostoni has received consulting honoraria from Abbott, Boston Scientific, Cordis, iVascular, Medtronic, Neovasc, Seven Sons, Teleflex, and Terumo. Dr Diletti has received consultant/proctoring honoraria from Asahi Intecc, Terumo, IMDS, Boston Scientific, Teleflex, and Philips. Dr Rathore has received honoraria for speaker and proctoring from Abbott Vascular and Translumina Therapeutics. Dr Bozinovic has served as a speaker or proctor and/or received honoraria from Orbus Neich and Medtronic. Dr Galassi has received consulting/speaker honoraria from Asahi Intecc and Ivascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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