Division of Cardiology, University Hospital P. Giaccone, Palermo, Italy.
Department of Cardiology and Angiology, University Heart Center, University of Freiburg, Freiburg, Germany; Department of Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany.
JACC Cardiovasc Interv. 2024 Oct 28;17(20):2425-2437. doi: 10.1016/j.jcin.2024.09.002.
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.
The study sought to describe the numbers, efficacy, and safety of each final CTO crossing strategy according to CTO-ARC recommendations.
In this cross-sectional study, data were retrieved from the European Registry of Chronic Total Occlusions between 2021 and 2022.
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%).
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.
慢性完全闭塞学术研究联合会（CTO-ARC）认识到，对慢性完全闭塞（CTO）经皮冠状动脉介入治疗方法的非标准化定义可能会使并发症归因于每种交叉策略产生偏差。
本研究旨在根据 CTO-ARC 建议描述每种最终 CTO 交叉策略的数量、疗效和安全性。
本横断面研究从 2021 年至 2022 年期间的欧洲 CTO 登记处中获取数据。
在 8673 例患者中，分别有 79.2%和 20.8%的患者接受了正向和逆向方法。正向方法包括正向布线和正向夹层再进入，两者均采用或不采用逆行辅助（无逆行辅助的正向布线：n=5929[68.4%]；有逆行辅助的正向布线：n=446[5.1%]；无逆行辅助的正向夹层再进入：n=353[4.1%]；有逆行辅助的正向夹层再进入：n=137[1.6%]）。逆向方法包括逆向布线（n=735[8.4%]）和逆向夹层再进入（n=1073[12.4%]）。与逆行和真正的正向交叉相比，替代的正向交叉与较低的技术成功率（分别为 70%、86%和 93.1%；P<0.001）和较高的并发症发生率（分别为 4.6%、2.9%和 1%；P<0.001）相关。然而，替代的正向交叉主要作为一种抢救策略应用（96.1%）。
应用 CTO-ARC 定义可将 6.7%的手术重新归类为有逆行或正向辅助的替代正向交叉，与真正的正向和逆向交叉相比，其主要不良心血管事件和死亡率（MACCE）更高，技术成功率更低。
