BACKGROUND The CTO-ARC (Chronic Total Occlusion Academic Research Consortium) recognized that a nonstandardized definition of chronic total occlusion (CTO) percutaneous coronary intervention approaches can bias the complications' attribution to each crossing strategy. OBJECTIVES The study sought to describe the numbers, efficacy, and safety of each final CTO crossing strategy according to CTO-ARC recommendations. METHODS In this cross-sectional study, data were retrieved from the European Registry of Chronic Total Occlusions between 2021 and 2022. RESULTS Out of 8,673 patients, antegrade and retrograde approach were performed in 79.2% and 20.8% of cases, respectively. The antegrade approach included antegrade wiring and antegrade dissection and re-entry, both performed with or without retrograde contribution (antegrade wiring without retrograde contribution: n = 5,929 [68.4%]; antegrade wiring with retrograde contribution: n = 446 [5.1%]; antegrade dissection and re-entry without retrograde contribution: n = 353 [4.1%]; antegrade dissection and re-entry with retrograde contribution: n = 137 [1.6%]). The retrograde approach included retrograde wiring (n = 735 [8.4%]) and retrograde dissection and re-entry (n = 1,073 [12.4%]). Alternative antegrade crossing was associated with lower technical success (70% vs 86% vs 93.1%, respectively; P < 0.001) and higher complication rates (4.6% vs 2.9% vs 1%, respectively; P < 0.001) as compared with retrograde and true antegrade crossing. However, alternative antegrade crossing was applied mostly as a rescue strategy (96.1%). CONCLUSIONS The application of CTO-ARC definitions allowed the reclassification of 6.7% of procedures as alternative antegrade crossing with retrograde or antegrade contribution which showed higher MACCE and lower technical success rates, as compared with true antegrade and retrograde crossing.

中文翻译：

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根据 CTO-ARC 共识建议，在 ERCTO 注册管理机构中对 CTO 交叉策略进行重新分类。


背景 CTO-ARC （慢性完全闭塞学术研究联盟） 认识到，慢性完全闭塞 （CTO） 经皮冠状动脉介入入入路的非标准化定义可能会使并发症归因于每种交叉策略。目的 该研究试图根据 CTO-ARC 建议描述每种最终 CTO 交叉策略的数量、有效性和安全性。方法 在这项横断面研究中，数据是从 2021 年至 2022 年间的欧洲慢性完全闭塞登记处检索的。结果 在 8,673 例患者中，分别有 79.2% 和 20.8% 的病例进行了顺行和逆行入路。顺行入路包括顺行布线和顺行夹层和折返，均有或无逆行贡献（顺行布线无逆行贡献：n = 5,929 [68.4%];顺行布线有逆行贡献：n = 446 [5.1%];顺行解剖和再入无逆行贡献：n = 353 [4.1%];顺行夹层和再入有逆行贡献：n = 137 [1.6%]）。逆行方法包括逆行布线 （n = 735 [8.4%]） 和逆行夹层和折返 （n = 1,073 [12.4%]）。替代顺行杂交与较低的技术成功率相关 （分别为 70% 和 86% 和 93.1%;P < 0.001）和较高的并发症发生率 （分别为 4.6% 和 2.9% 和 1%;P < 0.001） 与逆行和真正的顺行杂交相比。然而，替代顺行杂交主要用作一种救援策略 （96.1%）。结论 CTO-ARC 定义的应用允许对 6.与真正的顺行和逆行交叉相比，7% 的手术作为替代顺行杂交，具有逆行或顺行贡献，显示出更高的 MACCE 和更低的技术成功率。