Subintimal vs. Intraplaque Coronary Rechanneling. Do Results Vary?

Coronary rechanneling is difficult by nature, and there are several techniques for it aimed at improving technical success. Some of these strategies entail the subintimal crossing of the occluded segment, while others entail intraplaque crossing, without leaving the true lumen. However, there is scarce or no information on the results of both strategies.

Researchers analyzed 75 consecutive patients undergoing angiography and optical coherence tomography (OCT) after rechanneling, who were included in the ISAR-OCT-CTO (Intracoronary Stenting and Angiographic Results – Optical Coherence Tomography for Chronic Total Occlusions) registry. The study endpoints were stenosis diameter, lumen loss, and rate of uncovered or malapposed struts.

Intraplaque rechanneling was used in 46 patients, while dissection and re-entry techniques were used in 29 patients.

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There were no significant differences in terms of in-segment stenosis diameter (mean 36.9% vs. 31.2%; p = 0.656), in-stent late lumen loss (0.21 mm vs. 0.23 mm; p = 0.83), or in-segment late lumen loss (0.03 vs. 0.13; p = 0.39) between intraplaque vs. subintimal techniques.

The OCT imaging analysis showed comparable strut coverage (79.9% vs. 71.3%; p = 0.255) but much higher malapposition rates among patients in the subintimal technique group (6.6% vs. 13.6%; p < 0.001).

The use of dissection and re-entry techniques only predicted higher rates of strut malapposition.

Conclusion

Intraplaque and subintimal rechanneling techniques are associated with comparable mid-term angiographic results. Although the rate of uncovered struts is high after any rechanneling, it does not vary according to the technique used.

The only difference observed is a higher chance of strut malapposition with dissection and re-entry techniques.

Original title: Subintimal Versus Intraplaque Recanalization of Coronary Chronic Total Occlusions. Mid-Term Angiographic and OCT Findings From the ISAR-OCT-CTO Registry.

Reference: Erion Xhepa et al. J Am Coll Cardiol Intv 2019, Article in press.

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