Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Henry Ford Hospital, Detroit, Michigan, USA.
JACC Cardiovasc Interv. 2022 Nov 28;15(22):2284-2293. doi: 10.1016/j.jcin.2022.08.052.
There are limited data on the limited antegrade subintimal tracking (LAST) technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
The aim of this study was to analyze the frequency of use and outcomes of the LAST technique for CTO PCI.
We analyzed 2,177 CTO PCIs performed using antegrade dissection and re-entry (ADR) in the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) registry between 2012 and January 2022 at 39 centers. ADR was attempted in 1,465 cases (67.3%).
Among antegrade re-entry cases, LAST was used in 163 (11.1%) (primary LAST in 127 [8.7%] and secondary LAST [LAST after other ADR approaches failed] in 36 [2.5%]), the Stingray system (Boston Scientific) in 980 (66.9%), subintimal tracking and re-entry in 387 (26.4%), and contrast-guided subintimal tracking and re-entry in 29 (2.0%). The mean patient age was 65.2 ± 10 years, and 85.8% were men. There was no significant difference in technical (71.8% vs 77.8%; P = 0.080) and procedural (69.9% vs 75.3%; P = 0.127) success and major cardiac adverse events (1.84% vs 3.53%; P = 0.254) between LAST and non-LAST cases. However, on multivariable analysis, the use of LAST was associated with lower procedural success (OR: 0.61; 95% CI: 0.41-0.91). Primary LAST was associated with higher technical (76.4% vs 55.6%; P = 0.014) and procedural (75.6% vs 50.0%; P = 0.003) success and similar major adverse cardiac event (1.57% vs 2.78%; P = 0.636) rates compared with secondary LAST.
LAST was used in 11.1% of antegrade re-entry CTO PCI cases and was associated with lower procedural success on multivariable analysis, suggesting a limited role of LAST in contemporary CTO PCI.
慢性完全闭塞经皮冠状动脉介入治疗（PCI）中，有限顺向内膜下寻径（LAST）技术的数据有限。
本研究旨在分析 LAST 技术在慢性完全闭塞 PCI 中的应用频率和结局。
我们分析了 2012 年至 2022 年 1 月期间，在 39 个中心的 PROGRESS-CTO（慢性完全闭塞干预的前瞻性全球登记处）注册研究中，使用顺向夹层和再进入（ADR）进行的 2177 例 CTO PCI。ADR 尝试在 1465 例（67.3%）中进行。
在前向再进入病例中，LAST 在 163 例（11.1%）中使用（原发 LAST 在 127 例中[8.7%]，继发 LAST 在 36 例中[2.5%]），其中使用 Stingray 系统（波士顿科学公司）在 980 例（66.9%），内膜下跟踪和再进入在 387 例（26.4%），以及对比引导的内膜下跟踪和再进入在 29 例（2.0%）。患者平均年龄为 65.2±10 岁，85.8%为男性。LAST 组与非 LAST 组在技术成功率（71.8% vs 77.8%；P=0.080）和程序成功率（69.9% vs 75.3%；P=0.127）和主要心脏不良事件（1.84% vs 3.53%；P=0.254）方面无显著差异。然而，多变量分析显示，LAST 的使用与较低的程序成功率相关（OR：0.61；95%CI：0.41-0.91）。原发 LAST 与更高的技术成功率（76.4% vs 55.6%；P=0.014）和程序成功率（75.6% vs 50.0%；P=0.003）和相似的主要不良心脏事件（1.57% vs 2.78%；P=0.636）相关，与继发 LAST 相比。
LAST 在 11.1%的前向再进入 CTO PCI 病例中使用，多变量分析显示程序成功率较低，提示 LAST 在当代 CTO PCI 中的作用有限。
