Abstract 16809: The Safety and Efficacy of a Sub-Intimal Stenting After Retrograde Approach for Chronic Total Occlusions: Sub Analysis of the CartTm Registry
Background: The recanalization of chronic total occlusions (CTOs) in native coronary arteries no doubt represents one of the most technically challenging of interventional procedures. We have reported a new concept for CTO recanalization using bilateral approach including a CART technique is feasible, safe, and has a higher success rate than previous approach. The aim of this study was to evaluate the long term outcomes in CTO lesions after sub-intimal stenting after retrograde approach for chronic total occlusions.
Methods: A total of 224 consecutive patients (mean age 65 ± 13 years; 80.7 % males) who were enrolled in this prospective multicenter registry. This technique combines the simultaneous use of the antegrade and retrograde approaches. A subintimal dissection is created antegradely and retrogradely, which limit the extension of the subintimal dissection within the CTO portion. We evaluated the follow-up angiographic finding in CTO lesions after stenting in the subintimal space with CART technique.
Results: Of entire population, the CART technique was used in 112 (62.6%) of the cases with successful wire and balloon delivery through the collateral channels. Successful recanalization was achieved in 96% of the patients and the procedural success rate was 94%. DES was used in 98.2% (110/112) of the patients after successful revascularization. Angiographic follow-up was obtained in 78 patients treated with CART technique (mean follow-up period of 12.1±5.8 months). Of 78 patients, binary restenosis was observed in 15 cases (19.2%) and re-occlusion in 6 cases (6.3%) at follow-up. Peri-stent contrast staining (late acquired incomplete stent apposition) was observed in 6 cases (5.3%). At 12-month follow-up, rates of target vessel revascularization and major adverse cardiac events were 13.1% and 16.8%, respectively.
Conclusions: A retrograde approach for re-attempted CTO lesions using the CART technique is feasible and has a higher success rate than previous approaches. The angiographic long-term outcomes in sub-intimal stenting after retrograde approach for CTO lesions were comparable to those in ordinary stenting for CTO lesions.
- © 2010 by American Heart Association, Inc.