Clinical Outcomes Of Recanalization Of Coronary Chronic Total Occlusion Lesions With Stingray Devices-based ADR Technique

Background As the last bastion of Percutaneous Coronary Intervention,the incidence of chronic coronary occlusion(CTO)in coronary artery angiography is 10-20%.The traditional method of opening CTO lesions is divided into antegrade wire escalation and reversal wire escalation,although the experienced CTO-PCI success rate of experienced surgeons has exceeded 90%,the overall success rate is currently only 50-70%.In recent years,the gradual rise of Stingray system-based ADR technique provides a new option for the treatment of chronic total occlusion(CTO)of coronary artery diseases by percutaneous coronary intervention(PCI),However,the outcomes,safety,and efficient of the technique have not been reported in a larger patient cohort in china.Aim: To compare the safety and longterm prognosis of The traditional method(control group)and Stingray Devices-Based ADR Technique(experimental group)in the treatment of coronary heart disease with chronic total occlusion lesions(CTO).Methods: Patients with CTO leisions who underwent PCI in our department from April2016 to December 2018 were consecutively enrolled.Clinical data of patients during their hospitalization and major adverse cardiovascular events(MACE)were collected.A follow-up was conducted to detect long-term MACE after PCI.Results: A total of 372 patients with CTO lesions were enrolled and 85.2% of patients were men.control group were 285 patients(76.6%)while experimental group were 87 patients(23.4%).The J-CTO score(2.4±1.0 vs.2.5±1.0,p=0.46)and procedural success rate(90.9% vs.87.4%,p>0.05)were similar.Compared with control group,patients in experimental group had a more proportion of hypertension(37.9% vs.56.5%,p<0.01),dyslipidemia(1.4% vs.32.2%,p<0.01)and left ventricular ejection fraction(LVEF)<50%(46.3% vs.50.6%,p<0.01).In terms of the characteristics of CTO lesions,the ratio of calcification lesions(26.0% vs.57.5%,p<0.01),moderate to severe contortion lesions(6.3% vs.13.8%,p=0.03),length of occlusive lesions >20mm(75.1% vs.89.7%,p<0.01)and CTO lesions involving bifurcation(27.7% vs.42.2%,p<0.01)of experimental group were higher.In addition,in the experimental group,the proximal CTO lesions(3.0 ± 0.2vs.3.2 ± 0.3,p<0.01)and distal CTO lesions(2.7 ± 0.1 vs.2.9 ± 0.2,p<0.01)were significantly thick but the ratio of available reverse collateral was significantly lower(94.0%vs.66.7%,p<0.01).experimental group significantly reduced the wire passage time(147.7 ±87.4 vs.76.4 ± 61.6,p<0.01)and procedural time(208.2 ± 83.0 vs.175.1 ± 72.0,p<0.01).However,compared with control group,the experimental group had more stents per patient(1.0± 0.5 vs.2.0 ± 1.4,p<0.01),longer total stent length(30.0 ± 13.4 vs.63.6 ± 44.6,p<0.01),lost side struts(3.5% vs.17.2%,p<0.01)and distal hematoma(3.9% vs.26.7%,p<0.01)but there was no significant difference in the incidence of perforation(1.1% vs.2.3%,P=0.33),cardiac tamponage(0.4% vs.1.1%,P=1.0)or in-hospital MACE(5.3% vs.2.2%,P=0.13).After a follow-up of 23±8 months,there was no significant difference in the incidence of MACE between the two groups(10.8% vs.9.1%,P=0.68).Conclusions: Stingray-ADR can significantly reduce procedural time,improve procedural success rate of CTO-PCI and is associated with similar success rates and risk for complications as compared with control group.