الفهرس 
Vascular healing after percutaneous revascularization of chronic total occlusions
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Abstract
Abstract
Neointimal Healing Score After Contemporary DART (Dissection And Re-entry Techniques)
as Compared to TTT (True-to-True) Recanalization of CTO: A 6-Months OCT Follow-up Study
OBJECTIVE
The aim of this study was to assess vascular healing response across different CTO-PCI techniques using
optical coherence tomography (OCT) derived Neointimal Healing Score (NIHS).
BACKGROUND
Increased utilization of dissection and re-entry techniques (DART) has contributed to
increasing procedural success rates in contemporary CTO registries. Contemporary DART techniques
(Stingray with or without CrossBoss for antegrade, and reverse CART for retrograde) have replaced
precedent DART techniques and showed mid-term outcomes comparable to true-to-true approaches.
Differential neointimal healing after CTO PCI by various approaches remain to be identified.
METHODS
This was a prospective, observational, single center, study recruiting 50 consecutive patients with
appropriate indications for CTO PCI. The primary endpoint (EP) was the NIHS, which evaluates
the presence of uncovered and/or malapposed stent struts, and intraluminal filling defects as detected
by OCT 6months after the index procedure.
RESULTS
Fifty consecutive patients who had successful CTO-recanalization, provided consent for study
participation. DART and True-to-true approaches were used in 15 and 36 patients respectively. Strategy
selection was at operator discretion. Clinical and angiographic follow-up were done for all patients at 6-
months, while OCT was performed for 39 patients (76%). At 6 months, the primary EP of NIHS was 12.5
± 9.7 for all patients. NIHS was comparable between DART and True-to-true techniques (16.4 ± 14.4%
vs. 11.7 ± 8.4%; p= 0.5). No major adverse cardiovascular events MACE (defined as all-cause mortality,
myocardial infarction) were reported at 6 months.The secondary EP of target lesion revascularization
(either imaging or symptoms driven TLR) occurred in 20% of all patients with numerically higher rates in
DART compared to True-to-true techniques but n not achieving statistical significance (26.6 % vs. 16.6%;
p=0.4).
CONCLUSIONS
DART were associated with non-significant increase in NIHS compared to True-to-true techniques, while
they substantially increased CTO PCI success rates. Rates of TLR 6-months after CTO canalization were
low in this group.