Author + information
- Ananya V. Kondapalli1,
- Haekyung Jeon-Slaughter1,
- Ehrin Armstrong2,
- Nicolas W. Shammas3,
- Andrew Shammas3,
- Anand Prasad4,
- Ian Cawich5,
- Gerardo Rodriguez5,
- Mazen Abu-Fadel6,
- Emmanouil S. Brilakis7 and
- Subhash Banerjee1
- 1University of Texas Southwestern Medical Center, Dallas, TX
- 2Denver VA Medical Center, Denver, CO
- 3University of Iowa, Davenport, IA
- 4UT Health San Antonio, San Antonio, TX
- 5Arkansas Heart Hospital, Little Rock, AR
- 6Oklahoma University Health Science Center, Oklahoma City, OK
- 7Minneapolis Heart Institute, Minneapolis, MN
Subintimal (SI) and intraluminal (IL) crossing of infrainguinal chronic total occlusion (CTO) lesions is frequently used, however, comparative outcomes are lacking. This study compares postprocedural complications and outcomes between these two techniques.
We selected 1,335 CTO interventions in 1,001 patients from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry from January 2005 to October 2015. Outcomes are 30-day and 12-month all-cause mortality, major adverse cardiovascular events, repeat endovascular or surgical revascularization, target limb major amputation, and procedural complications.
SI crossing technique was used in 388 lesions (27%) with lower procedural (p<0.01) and technical (p<0.01) success than the IL technique (Figure 1.A). There was no significant group difference in procedural complications, 30-day and 12-month postprocedural outcomes. 12-month stent thrombosis (ST) was higher in the SI crossing technique (3.0% vs. 1.2%; p=0.04; Figure 1.B). Lesions in the SI group were significantly longer (111.6±24.4 vs. 107.7±24.1, p<0.01) and had a larger reference vessel diameter (4.6±0.3 vs. 4.5±0.4, p<0.01) compared to the IL group.
Subintimal crossing of infrainguinal chronic total occlusion lesions was employed to cross longer lesions. It is associated with similar postprocedural complications and outcomes, albeit with significantly higher stent thrombosis.