The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical and Angiographic Outcomes of Crossing Techniques for Coronary Chronic Total Occlusions - The ISAR-CTO Registry

DOI: 10.4244/EIJ-D-20-01248

1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München,Technical University of Munich, Germany, Germany
2. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München
3. Department of Diagnostic and Interventional Radiology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
4. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention and external reviewers - has been published immediately upon acceptance as it was received in the last round of revision. The content of this article is the responsibility of the authors.

Please note that supplementary movies are not available online at this stage. Once a paper is published in its edited and formatted form, it will be accompanied online by any supplementary movies.

To read the full content of this article, please log in to download the PDF.


Clinical and angiographic outcomes following recanalization of coronary chronic total occlusions (CTO) through contemporary dissection and reentry techniques (DART) as opposed to intraplaque techniques remain controversial.


To compare clinical and angiographic outcomes following subintimal and intraplaque CTO recanalization.


453 consecutive patients undergoing successful CTO recanalization (473 vessels) were included. Intraplaque techniques were used in 403 (85.2%) and DART in 70 (14.8%) vessels. Surveillance angiography was scheduled at 6-9 months and clinical follow-up was performed up to 12 months.


No significant differences in terms of cumulative incidence of MACE (P=0.862) or binary restenosis (P=0.320) were present between the two groups. There was no independent correlation between recanalization technique and MACE occurrence or in-segment binary restenosis. Target lesion revascularization (TLR) was performed in 60 (15.5%) and 12 (17.9%) (P=0.678) lesions respectively. The occurrence of occlusive restenosis was low [7 (2.3%) vs. 1 (1.6%); P=0.824] and comparable between groups.


Contemporary DART are associated with similar mid-term clinical and angiographic outcomes compared to intraplaque recanalization. Rate of occlusive restenosis was low and comparable in both groups. Regardless of recanalization technique, overall incidence of binary restenosis and TLR following CTO recanalization remain higher than those reported for non-CTO PCI.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

Read next article
Infective endocarditis after TAVI; IVUS assessment in valve-in-valve procedures; a mini focus on antithrombotic therapy in coronary interventions; an EAPCI position statement on elective procedures during COVID-19; and more…