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Comparative outcomes of parallel-wire and antegrade wire escalation techniques following single-wire failure in CTO PCI – a long-term follow-up study
ДУГОРОЧНО ПРАЋЕЊЕ УПОРЕДНИХ ИСХОДА ТЕХНИКЕ ПАРАЛЕЛНИХ ЖИЦА И ТЕХНИКЕ ЕСКАЛАЦИЈЕ АНТЕРОГРАДНЕ ЖИЦЕ НАКОН НЕУСПЕХА ИНИЦИЈАЛНЕ ЖИЦЕ У ПЕРКУТАНОЈ РЕКАНАЛИЗАЦИЈИ ХРОНИЧНИХ ТОТАЛНИХ ОКЛУЗИЈА КОРОНАРНИХ АРТЕРИЈА
- Часопис
- Serbian Archives of Medicine
- Објављено
- Srp Arh Celok Lek. 2025;153(9–10):441–447.
- Врста рада
- ORIGINAL ARTICLES
Abstract
Introduction/Objective Following the failure of the single-wire technique in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), two principal antegrade escalation strategies are commonly employed: the parallel-wire technique and antegrade wire escalation (AWE). Despite their widespread use, comparative data on the procedural characteristics and long-term clinical outcomes of these strategies remain scarce. This study aims to compare the procedural parameters and long-term outcomes of the parallel-wire and AWE techniques after single-wire failure in CTO PCI.
Methods This retrospective, single-center study included patients who underwent successful CTO PCI between January 2018 and December 2023 using either the parallel-wire or AWE technique following single-wire failure. The primary endpoint was a composite of cardiac death, myocardial infarction, stroke, or target vessel revascularization (TVR). Secondary outcomes included procedure duration, fluoroscopy time, contrast volume, and total radiation dose. Median follow-up duration was 1222 days (IQR 580–1969 days).
Results Among 270 CTO PCI procedures, 112 (41.5%) required escalation: 90 with AWE and 22 with the parallel-wire technique. Baseline clinical and angiographic characteristics were comparable. The primary composite outcome occurred in 14.4% of the parallel-wire group and 9.1% of the AWE group (p = 0.73). No significant differences were observed in individual clinical events. Procedure duration was longer (95.5 ± 43.6 vs. 77.0 ± 30.7 min; p = 0.064) and contrast volume higher (336.4 ± 113.3 vs. 271.6 ± 90.6 mL; p = 0.014) in the AWE group, with similar fluoroscopy time and radiation dose. No clinically or angiographically significant complications occurred during the periprocedural period.
Conclusion Both AWE and parallel-wire techniques demonstrate comparable safety and efficacy following single-wire failure in CTO PCI. While procedural efficiency slightly favored the parallel-wire strategy, overall outcomes support either approach, pending further prospective validation.
Keywords: chronic total occlusion; percutaneous coronary intervention; antegrade approach; wire escalation; parallel wire