Antegrade Dissection and Re-entry Versus Retrograde Strategy in Chronic Total Occlusion Percutaneous Coronary Intervention

What this Trial Is About

Researchers are evaluating two approaches for coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI): antegrade dissection and re-entry (ADR) versus the retrograde strategy. The study aims to compare procedural outcomes such as total procedure time, success rates of guidewire crossing, procedural complications, and stress levels experienced by interventional cardiologists. It also examines whether the retrograde approach leads to higher rates of myocardial injury or infarction based on cardiac troponin levels and cardiac magnetic resonance (CMR). Participants with difficult CTO lesions will undergo pre-procedural assessments including cardiac magnetic resonance imaging, laboratory tests for cardiac markers, and health status questionnaires. Those with failed or unattempted primary antegrade wiring will be randomly assigned to either ADR or retrograde strategy groups. Patients with successful antegrade wiring will be followed in an observational arm. After the procedure, cardiac enzyme levels and CMR will be repeated, and health status reassessed three months later. The physical and mental stress of the cardiologists performing the procedures will also be monitored. Participants will be involved in laboratory testing before and after PCI, CMR scans within five days post-procedure, and health questionnaires at baseline and three months. Researchers will measure outcomes including procedure duration, guidewire crossing success, radiation exposure, contrast use, complications, myocardial injury and infarction, quality of life, and target lesion failure at three months. Stress indicators for physicians will be recorded during the procedure. The study lasts from procedure day through three months follow-up.

Antegrade Dissection and Re-entry Versus Retrograde Strategy in CTO PCI