RESUMO
Objective: Recanalization of in-stent chronic total occlusion (IS-CTO) is challenging and has resulted in inconsistent results. The aim of our study was to analyze the influence of the individual coronary vessels on the acute outcomes following IS-CTO PCI. Methods: This was an observational retrospective study, including 66 patients undergoing recanalization of a CTO. The CTO interventions were performed bi-femoral using 7-French guiding catheters. A composite endpoint summarizing severe complications was evaluated, including emergency coronary artery bypass grafting surgery (CABG) and cardiac death. Results: We subdivided our cohort into three groups (LAD group, LCX group, RCA group). The retrograde technique and the utilization of an extension catheter were used more frequently in patients with a RCA IS-CTO. There was no significant difference between the composite safety endpoints amongst the three groups. Technical success was independent of the involved vessel. Conclusions: Success and complication rates are independent of the occluded vessel. This challenging and complex coronary intervention is feasible and can be carried out in complete safety.
RESUMO
BACKGROUND: The Corsair collateral channel dilator was designed for retrograde passage in cases of coronary chronic total occlusion (CTO). Its antegrade use is discouraged and the number of published studies regarding such use is limited. Our single-operator experience examines the feasibility and safety of the Corsair in antegrade recanalization of chronic CTOs in a large cohort. METHODS: We queried the European Registry of Chronic Total Occlusion (ERCTO) for all microcatheters used in antegrade recanalizations between 2008 and 2016. We also retrospectively assessed all 722 coronary interventions for CTOs (624 antegrade, 98 retrograde) between January 2008 and December 2016, performed by a single operator who primarily applied the Corsair as antegrade microcatheter. Patient, procedure, and outcome data was analyzed. RESULTS: In 17,787 cases performed by 93 operators contributing to the ERCTO database, there were 3294 with information on microcatheter type. The FineCross MG (73.9 %) was the most commonly used microcatheter. The Corsair was used in only 1.2 % (excluding patients in the single-operator cohort). In the same period 45.7 % (n = 285) of all 624 antegrade cases handled by our single operator were performed using the Corsair, with no exclusions due to anatomical or morphological criteria. The procedural success rate was 93.7 %. There were 2 cases of cardiac tamponade, 5 cases of minor perforation, and one catheter tip fracture. CONCLUSIONS: The Corsair is rarely used for antegrade recanalization. In this single-operator experience, the antegrade use of the Corsair was safe. The success rate was high, although causative conclusions cannot be drawn.