Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2025-03-10 DOI:10.1002/ccd.31472

Deniz Mutlu, Dimitrios Strepkos, Ozgur Selim Ser, Pedro E. P. Carvalho, Michaella Alexandrou, Sandeep Jalli, Lorenzo Azzalini, Luiz Ybarra, Khaldoon Alaswad, Farouc A. Jaffer, Rhian Davies, Bavana V. Rangan, Yader Sandoval, M. Nicholas Burke, Sevket Gorgulu, Emmanouil S. Brilakis, PROGRESS-CTO Investigators

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Abstract

Background

The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Aims

To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.

Methods

We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.

Results

Among 1353 CTO PCIs with failed AW with a single wire, traditional parallel wiring (n = 1081) or DLMC-assisted parallel wiring (n = 272) were utilized at the operator's discretion. The baseline characteristics of patients were similar in both groups except for higher prevalence of diabetes mellitus, and lower prevalence of hypertension, prior heart failure, prior MI and cerebrovascular disease in DLMC patients. Lesions in the DLMC group were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate/severe calcification, and had higher J-CTO score (2.6 ± 1.0 vs. 2.1 ± 1.3, p < 0.001). Technical (87.1% vs. 74.3%, p < 0.001) and procedural (83.8% vs. 75.5%, p = 0.001) success and the incidence of in-hospital major cardiac adverse events (MACE) (4.8% vs. 2.0%, p = 0.020) were higher in the DLMC group. In propensity score matching analysis, DLMC-assisted wiring was associated with higher technical success (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33−3.54, p = 0.002) and no significant difference in MACE (OR 2.00, 95% CI 0.89−4.50, p = 0.093).

Conclusions

In lesions that could not be crossed with AW, DLMC-assisted parallel wiring was associated with a higher likelihood of technical success, without an increased risk of MACE, compared with traditional parallel wiring.

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慢性全闭塞经皮冠状动脉介入治疗中传统与双腔微导管辅助平行布线：来自PROGRESS-CTO注册的见解。

背景：在慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中，传统与双腔微导管（DLMC）辅助平行布线的有效性和安全性的研究还很有限。目的：比较传统与双腔微导管（DLMC）辅助平行布线。方法：我们在一个大型、多中心CTO PCI注册表中比较了传统与dlmc辅助平行线在顺行线（AW）失败后的临床和血管造影特征和结果。结果：在1353个单线失效的CTO pci中，根据操作人员的判断，采用传统平行布线（n = 1081）或dlmc辅助平行布线（n = 272）。两组患者的基线特征相似，除了糖尿病的患病率较高，DLMC患者高血压、既往心力衰竭、既往心肌梗死和脑血管疾病的患病率较低。DLMC组的病变更容易出现近端帽模糊，近端帽侧分支，钝/无残端，中度/重度钙化，J-CTO评分更高（2.6±1.0 vs. 2.1±1.3,p）。结论：在不能与AW交叉的病变中，DLMC辅助的平行线与更高的技术成功可能性相关，与传统的平行线相比，没有增加MACE的风险。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.

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