Impact of Switch Time between Cto Crossing Strategies
Russia
The switch time from one crossing technique to another may be crucial in patients with complex CTOs which required multiple recanalization strategies. The purpose of our study was to analyze the effect of switch time between crossing techniques on the procedural success CTO PCI.
Between 2013 and 2017, 99 CTO PCI using both antegrade and retrograde strategies were performed in Meshalkin National Medical Research Center. In all cases crossover from antegrade to retrograde was implemented. To determine the threshold value, time was step-wise categorized (using cut-offs of 2, 4, 6 mins and so on) and tested in the logistic regression. Median age was 58.9±7.2 years.
The threshold value of time to switch crossing technique was 33 min. Of the 66 patients with time below 33 min, there were 53 cases (80.3%) of procedural success. By contrast, there were 18 (54.5%) cases of success among those with the switch time greater than 33 min. Therefore, the odds of procedural success with earlier switch were 3.4 times higher (95% CI: 1.3 to 8.6). The chances of success reduced by 3% for every 1 min longer the threshold value of time (the OR of 0.97; 95% CI 0.94 to 0.99, p=0.05). Mean procedure time was 62.3 ± 27.7 min. The average switch time between crossing strategies was 28.2 ± 16.9 min. Switch to the retrograde approach should be considered no later than after 33 minutes of the antegrade wire manipulation in order to maintain the maximum chances of a final technical success.
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