Long-Term Outcomes of Successful CTO PCI Using Antegrade and Retrograde Dissection and Re-entry Technique: The LOTUS study

BackgroundThere are always concerns regarding the durability of subintimal stenting after contemporary chronic total occlusion (CTO) recanalization. MethodThis prospective, multicenter clinical trial aimed to compare extraplaque (EP) and intraplaque (IP) tracking for long-term clinical outcomes after CTO recanalization. After IVUS assessment of the wire crossing position, the patients were divided into two groups: (1) the EP group with subintimal length (SL) > 10 mm; and (2) the IP group with intraplaque or minor extraplaque (SL [&le;] 10 mm). The primary endpoint was binary in-segment restenosis (ISR), and the secondary endpoint was the occurrence of major adverse cardiac events. Angiographic follow-up (FU) was scheduled at 13 months, and clinical FU was continued up to 3 years. ResultsA total of 257 successful CTO patients were enrolled. The mean CTO length in the EP group was 46.6 {+/-} 16.1 mm, and the median extraplaque length was approximately 24.5 mm. The J-CTO score was higher (p<0.001). Angiographic FU at 13 months showed that both groups had similar cumulative rates of ISR (p = 0.704). In the 3-year clinical follow-up, the cumulative incidence of target vessel revascularization (TVR) in both groups and across different tracking techniques showed no significant difference (p > 0.05). Independent predictors of ISR were a total stent length >50 mm and a wire crossing time >2 hours, while multivessel lesions showed an independent association with 3-year TVR. ConclusionThe specific long extraplaque tracking had comparable angiographic and long-term clinical outcomes to intraplaque tracking, regardless of the crossing technique used. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=131 SRC="FIGDIR/small/25335543v1_ufig1.gif" ALT="Figure 1"> View larger version (57K): org.highwire.dtl.DTLVardef@12c7eb1org.highwire.dtl.DTLVardef@31b5d7org.highwire.dtl.DTLVardef@1995106org.highwire.dtl.DTLVardef@967746_HPS_FORMAT_FIGEXP M_FIG C_FIG