The impact of dissection and re-entry versus wire escalation techniques on one-year clinical outcomes in patients with chronic total occlusion

Said El Keshk, Eman; Abd El Khalek El Darky, El Sayed; El Sayed Abd El Hamid Ammar, Ahmed; Mohamed Sabry, Al Shimaa

doi:10.21608/bjas.2025.343758.1552

The impact of dissection and re-entry versus wire escalation techniques on one-year clinical outcomes in patients with chronic total occlusion

Document Type : Original Research Papers

Authors

¹ Assistant Professor of Cardiovascular Medicine, Faculty of Medicine, Benha University, Benha, Egypt

² Professor of Cardiovascular Medicine, Faculty of medicine, Benha University, Benha, Egypt

³ M.Sc., Faculty of Medicine, Zagazig University, Egypt

10.21608/bjas.2025.343758.1552

Abstract

Three distinct degrees of assurance about occlusion length are defined in the Euro CTO club consensus statement. Without a doubt: The flow was verified to be TIMI grade 0 in an earlier angiography performed more than three months ago.Most likely: More than three months ago, a clinical diagnosis of acute myocardial infarction was made in the area of the blocked artery.Unknown: chronic total occlusion (CTO) with TIMI grade 0 flow and angiographic evidence of chronic occlusion; three months of stable angina symptoms have not improved. An epicardial coronary artery blockage with no antegrade flow, mature collaterals, no thrombus, no proximal cap staining, and a duration of three months or more is defined as a chronic complete occlusion (CTO) by the CTO Academic Research Consortium (CTO-ARC). The terms "intraplaque" (wire tracking inside plaque) and "extraplaque" (outside plaque but within adventitia) have been substituted for "true lumen" and "subintimal"(1) in the CTO-ARC paper. By doing away with the word "escalation" to represent both the escalation and de-escalation of wire tip-load, it creates two new categories for crossing techniques: antegrade wiring (AW) and retrograde wiring (RW).

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