Antegrade Dissection and Reentry Technique Evaluated With Boston Scientific's CrossBoss and Stingray Devices for Hybrid CTO Treatment
June 19, 2017—Findings from a subanalysis of the RECHARGE registry that sought to evaluate antegrade dissection and reentry (ADR) as part of the hybrid chronic total occlusion (CTO) revascularization strategy were published by Joren Maeremans, MSc, et al online ahead of print in Circulation: Cardiovascular Interventions.
According to the investigators, development of the CrossBoss and Stingray devices (Boston Scientific Corporation) for ADR of CTOs has historically improved suboptimal outcomes. However, the outcomes, safety, and failure modes of the technique have to be studied in a larger patient cohort. This preplanned substudy of the RECHARGE registry aims to evaluate the value and use of ADR and determine its future position in contemporary CTO intervention. RECHARGE is a registry of CrossBoss and hybrid procedures in France, the Netherlands, Belgium, and the United Kingdom.
As summarized in Circulation: Cardiovascular Interventions, the investigators selected patients from the registry if an ADR strategy was applied. They assessed outcomes, safety, and failure modes of the technique.
The ADR technique was used in 292 (23%) of the 1,253 patients in the RECHARGE registry and was mainly applied for complex lesions (Japanese CTO score = 2.7 ± 1.1). ADR was the primary strategy in 88 (30%) of the 292 ADR patients, with a 67% success rate. Bailout ADR strategies were successful in 63% (133/210). The controlled ADR (ie, combined CrossBoss/Stingray) subtype was applied most frequently (32%; 93/292) and successfully (81%; 75/93).
The overall per-lesion success rate was 78% (229/292), after use of additional bailout strategies. The inability to reach the distal target zone (48/100) or to reenter (43/100) most commonly led to failure. ADR-associated major events occurred in 3.4% (10/292) of procedues.
The investigators concluded that although it was mostly applied as a bailout strategy for complex lesions, the frequency, outcomes, and low complication rate of the ADR technique and its subtypes confirm the benefit and value of the technique in hybrid CTO percutaneous coronary intervention, especially when antegrade wiring or retrograde approaches are not feasible, concluded the investigators in Circulation: Cardiovascular Interventions.