E-Abstract

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP A-040

Efficacy of Angio-Based and Tip-Detection Three-Dimensional Wiring Method for Chronic Total Occlusion Percutaneous Coronary Intervention

By Toshikazu Kashiyama, Atsunori Okamura, Mutsumi Iwamoto, Satoshi Watanabe, Akinori Sumiyoshi, Kota Tanaka, Takamasa Tanaka, Kenshi Fujii

Presenter

Toshikazu Kashiyama

Authors

Toshikazu Kashiyama1, Atsunori Okamura2, Mutsumi Iwamoto3, Satoshi Watanabe3, Akinori Sumiyoshi3, Kota Tanaka3, Takamasa Tanaka4, Kenshi Fujii3

Affiliation

Sumitomo Hospital, Japan1, Sakurabashi Watanabe Advanced Healthcare Hospital, Japan2, Sakurabashi Watanabe Hospital, Japan3, Hyogo College, Japan4
View Study Report
TCTAP A-040
Chronic Total Occlusion

Efficacy of Angio-Based and Tip-Detection Three-Dimensional Wiring Method for Chronic Total Occlusion Percutaneous Coronary Intervention

Toshikazu Kashiyama1, Atsunori Okamura2, Mutsumi Iwamoto3, Satoshi Watanabe3, Akinori Sumiyoshi3, Kota Tanaka3, Takamasa Tanaka4, Kenshi Fujii3

Sumitomo Hospital, Japan1, Sakurabashi Watanabe Advanced Healthcare Hospital, Japan2, Sakurabashi Watanabe Hospital, Japan3, Hyogo College, Japan4

Background

Angio-based and tip-detection three-dimensional (3D) wiring methods came to be acknowledged as novel strategies for chronictotal occlusion (CTO) percutaneous coronary intervention (PCI), but comparison with conventional wire crossing techniques has yet to be made.

Methods

We retrospectively enrolled 126 consecutive CTO PCIcases. Wire-manipulation time was compared between adopted wiring strategies. The rate of successful wire crossing using angio-based and tip-detection 3D wiring techniques was analyzed according to the variables in the complexity scores.

Results

Antegrade wire crossing was successfully accomplished in 99 (78.5%) lesions, including 31 (24.6%) and 34 (26.9%) using angio-based and tip-detection 3D wiring techniques, respectively. Success rate within 30 minutes was significantly higher with the tip-detection 3D wiring technique than with retrograde approach (57.5% vs. 12.8%, odds ratio [OR]: 8.91, 95% CI =2.70-35.4, p < 0.001). Severe calcification (OR: 0.23, 95% CI: 0.07-0.68, p= 0.004) and reattempted cases (OR: 0.16, 95% CI: 0.01-0.81, p = 0.01) were predictive of incomplete angio-based 3D wiring crossing. In addition, incomplete tip-detection wire crossing (taking >30 min) was seen in severely tortuous lesions (OR: 0.19, 95% CI: 0.03-0.88, p = 0.02).

Conclusion

The tip-detection 3D wiring technique can dramatically reduce the wire-crossing time compared with the retrograde approach. The success rate of the angio-based 3D wiring technique is negatively impacted by calcified lesions and previously failed attempts, and that of the tip-detection 3D wiring technique is hampered by lesion tortuosity.