Key result
An IVUS-identified AW-subintima/RW-intraplaque mismatch during retrograde chronic total occlusion intervention was associated with the most complex morphology, requiring wire repositioning in 97% of cases compared to 11% when both wires were intraplaque.
Why the study?
Connecting the antegrade and retrograde wires is a goal of CTO treatment, but angiographic guidewire location is sometimes misleading.
Does IVUS-identified antegrade and retrograde wire position predict the need for wire repositioning and procedural success during retrograde CTO intervention?
Observational (n=191)
Yes
Does IVUS-identified antegrade and retrograde wire position predict the need for wire repositioning and procedural success during retrograde CTO intervention?
Answers are grounded in this paper and cite their sources.
During retrograde CTO PCI, an IVUS-identified pattern of a subintimal antegrade wire and an intraplaque retrograde wire is associated with the highest procedural complexity and almost always requires wire repositioning for success.
BACKGROUND: Connecting the antegrade wire (AW) and the retrograde wire (RW) is a goal of chronic total occlusion (CTO) treatment, but angiographic guidewire location is sometimes misleading. AIMS: The aim of this study was to evaluate the association between intravascular ultrasound (IVUS)-defined AW and RW position and procedural outcomes when treating CTO lesions using the retrograde approach. METHODS: Overall, 191 CTO lesions treated using an IVUS-guided retrograde approach at three centres in Japan, China, and the USA were included. RESULTS: When the AW and RW angiographically overlapped, four wire positions were seen on IVUS: (i) AW within the plaque (AW-intraplaque) and RW-intraplaque in 34%; (ii) AW-intraplaque and RW in the subintimal space (RW-subintima) in 28%; (iii) AW-subintima and RW-subintima in 22%; or (iv) AW-subintima and RW-intraplaque in 16%. The procedure succeeded without repositioning the wire in 89% of AW-intraplaque/RW-intraplaque, 61% of AW-intraplaque/RW-subintima and 57% of AW-subintima/RW-subintima, but only one (3%) AW-subintima/RW-intraplaque. Lesion and procedure complexity and failure/complications were greatest in AW-subintima/RW-intraplaque. CONCLUSIONS: IVUS-identified vascular compartment concordance versus IVUS-identified vascular compartment mismatch leads to higher success rates irrespective of intraplaque or subintimal passage. AW-subintima/RW-intraplaque was associated with the most complex CTO morphology and procedure, and repositioning the wire was almost always necessary. Visual summary. When the antegrade wire is in the subintimal space and the retrograde wire is in the intraplaque, re-wiring is almost always necessary.
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Fan et al. (2021) conducted an observational in Chronic total occlusion (CTO) (n=191). IVUS-identified AW-intraplaque/RW-intraplaque wire position vs. AW-subintima/RW-intraplaque wire position was evaluated on Procedural success without repositioning the wire. An IVUS-identified AW-subintima/RW-intraplaque mismatch during retrograde chronic total occlusion intervention was associated with the most complex morphology, requiring wire repositioning in 97% of cases compared to 11% when both wires were intraplaque.
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