Efficacy of the tip-detection method over the retrograde approach for chronic total occlusion percutaneous coronary intervention

Abstract

Abstract Background The tip-detection method has been acknowledged as a novel strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) when conventional antegrade wiring strategies are ineffective, but a comparison with the retrograde approach has yet to be carried out. Method We retrospectively enrolled 170 consecutive CTO PCI cases and separated them according to the adopted strategies. The wire-manipulation time for each strategy was compared between the tip-detection method and the retrograde approach. The rate of successful wire crossing was analyzed according to the variables in the complexity scores. Results Fifty-six attempts with the tip-detection method were observed, with 46 (82.1%) successful cases. Sixty-one retrograde approaches were performed, in which 29 (47.5%) cases achieved procedural success. In the successful attempts, the wire-manipulation time was significantly shorter with the tip-detection method (20.0 [12.2-36.7] min) than with the retrograde approach (35.0 [20.7-49.7] min) (p=0.008). Incomplete tip-detection wire crossing (taking >30 min) was seen in severely tortuous lesions (odds ratio: 0.26, 95% confidence interval: 0.06–0.97, p = 0.037). Conclusions The tip-detection method can improve the rate and time required for successful CTO PCI compared with the retrograde approach. However, the success rate of the tip-detection method is hampered by lesion tortuosity.Figure