Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry

Barbara Anna Danek, Aris Karatasakis, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W. Yeh, Farouc A. Jaffer, Mitul Patel, John Bahadorani, William L. Lombardi, Michael R. Wyman, J. Aaron Grantham, Anthony Doing, Jeffrey W. Moses, Ajay Kirtane, Manish Parikh, Ziad A. Ali, Sanjog Kalra, David E. Kandzari, Nicholas Lembo, Santiago GarciaBavana V. Rangan, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR). Methods We examined outcomes of ADR among 1313 CTO PCIs performed at 11 US centers between 2012-2015. Results 84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9%). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8 ± 1.2 vs. 2.4 ± 1.2, p < 0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p = 0.005) and procedural success (85.0% vs. 90.7%, p = 0.002), but similar risk for MACE (2.9% vs. 2.2%, p = 0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p < 0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p = 0.43), procedural success (91.8% vs. 94.1%, p = 0.23), and MACE (2.1% vs. 0.6%, p = 0.12). Conclusions ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.

Original languageEnglish (US)
Pages (from-to)428-437
Number of pages10
JournalInternational Journal of Cardiology
StatePublished - Jul 1 2016

Bibliographical note

Funding Information:
Study data were collected and managed using REDCap electronic data capture tools hosted at University of Texas Southwestern Medical Center.2 REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources.


  • Chronic total occlusion
  • Complications
  • Dissection and re-entry
  • Outcomes
  • Techniques

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