Author + information
- Received December 5, 2019
- Revision received March 19, 2020
- Accepted March 24, 2020
- Published online June 15, 2020.
- Simon J. Walsh, MDa,∗ (, )
- Colm G. Hanratty, MDa,
- Margaret McEntegart, MDb,
- Julian W. Strange, MDc,
- Johannes Rigger, MDa,
- Peter A. Henriksen, MDd,
- Elliot J. Smith, MDe,
- Simon J. Wilson, MDa,
- Jonathan M. Hill, MDf,
- Zlatko Mehmedbegovic, MDg,
- Bernard Chevalier, MDh,
- Marie-Claude Morice, MDh and
- James C. Spratt, MDi
- aBelfast Health & Social Care Trust, Belfast, United Kingdom
- bGolden Jubilee Hospital, Glasgow, United Kingdom
- cBristol Heart Institute, Bristol, United Kingdom
- dRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom
- eSt. Bartholemew’s Hospital, London, United Kingdom
- fKing’s College Hospital, London, United Kingdom
- gClinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia
- hCardiovascular European Research Centre, Massy, France
- iSt. George’s University Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Simon J. Walsh, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom.
Objectives The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques.
Background Reliable procedural success and safety in CTO PCI require the use of DART to treat the most complex patients. Potential concerns regarding the durability of DART with SI stenting still need to be addressed.
Methods This was a prospective, multicenter, single-arm trial of patients with appropriate indications for CTO PCI.
Results Successful CTO PCI was performed in 210 of 231 patients (91% success). At 1 year, the primary endpoint of target vessel failure (cardiac death, myocardial infarction related to the target vessel, or any ischemia-driven revascularization) occurred in 5.7% of patients, meeting the pre-set performance goal. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or target vessel revascularization) occurred in 10% at 1 year and 17% by 2 years and was not influenced by DART. Quality-of-life measures significantly improved from baseline to 12 months. There was no difference in intravascular healing assessed using optical coherence tomography at 12 months for patients treated with DART and SI stenting compared with intimal strategies.
Conclusions Contemporary CTO PCI is associated with medium-term clinical outcomes comparable with those achieved in other complex PCI cohorts and significant improvements in quality of life. The use of DART with SI stenting does not adversely affect intravascular healing at 12 months or medium-term major adverse cardiovascular events. (Consistent CTO Trial; NCT02227771)
- chronic total occlusion
- optical coherence tomography
- percutaneous coronary intervention
- quality of life
This research was supported by an unrestricted grant from Boston Scientific. Dr. Walsh is a consultant to and has received research funding from Abbott Vascular and Boston Scientific; and is a consultant to Medtronic and Teleflex. Dr. Hanratty is a consultant to Abbott Vascular, Boston Scientific, Medtronic, and Teleflex. Dr. Strange is a consultant to Abbott Vascular; and is a proctor for and has received honoraria from Boston Scientific. Dr. Smith is a proctor for and has received honoraria from Boston Scientific. Dr. Hill is a consultant to and has received research funding from Abbott Vascular, Abiomed, Boston Scientific, Medtronic, and Shockwave Medical. Dr. Spratt is a consultant to Abbott Vascular, Boston Scientific, and Teleflex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 5, 2019.
- Revision received March 19, 2020.
- Accepted March 24, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.