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

JACC Cardiovasc Interv. 2024 Oct 28;17(20):2425-2437. doi: 10.1016/j.jcin.2024.09.002.

Abstract

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.

Keywords: ADR; Academic Research Consortium on CTO; CTO PCI; CTO PCI complications; CTO-ARC; antegrade dissection and re-entry; chronic total occlusions percutaneous coronary intervention; retrograde approach.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Chronic Disease
  • Clinical Decision-Making
  • Consensus*
  • Coronary Occlusion* / diagnostic imaging
  • Coronary Occlusion* / therapy
  • Cross-Sectional Studies
  • Europe
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / adverse effects
  • Practice Guidelines as Topic
  • Registries*
  • Risk Assessment
  • Risk Factors
  • Terminology as Topic
  • Time Factors
  • Treatment Outcome