The Comparison of hybrid approach versus single crossing strategies to coronary CTO-PCI

Abstract

BACKGROUND. Most attempts to intervene on coronary chronic total occlusions fail because the wire cannot cross the occlusion. Three main strategies can be used to cross a CTO: antegrade wire escalation, antegrade dissection/re-entry and retrograde. The basic underlying principle of the hybrid approach (HA) is that no single procedural crossing strategy should be pursued to exhaustion, but an alternative strategy should be attempted if a given crossing strategy does not progress. AIM. To evaluate the difference in success, complication rates, procedural characteristics and clinical outcomes of single CTO crossing strategies versus hybrid approach to coronary CTO-PCI. METHODS. The success rates, complication rates, procedural characteristics and clinical outcomes of 72 consecutive CTO-PCIs with single crossing strategy (control group) were compared to 34 cases of hybrid approach to CTO-PCI. In the HA group succesful crossing strategy was assessed. The SYNTAX and J-CTO scores were assessed to evaluate the potential severity of the procedure. Procedural characteristics were evaluated by numbers of stents, wires, microcatheters, amount of dye used, total fluoroscopy time, air kerma radiation dose and total procedural time. The complications included major adverse cardiac and cerebrovascular events (MACCE) (defined as death, myocardial infarction, emergent coronary bypass surgery, repeat PCI, or stroke) and the procedural complications such as acute or sub-acute occlusion, distal embolization, coronary dissection, and coronary perforation. At 6 month follow-up clinical outcomes including target vessel revascularization (TVR), target lesions revascularization (TLR) and major adverse cardiac events (MACE) were evaluated. RESULTS. Procedural success was achieved in 91.2% cases in HA group and was significantly higher than cases in control group (86.1% respectively). The final successful CTO crossing strategy in HA group was