Background: There are limited data on the limited antegrade subintimal tracking (LAST) crossing technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed the frequency of use and outcomes of LAST among 2,003 CTO PCIs performed with antegrade dissection and re-entry (ADR) in the PROGRESS-CTO Registry between 2012 and 2021 at 39 centers.
Results: LAST was used in 144 cases (7.2%), primary LAST in 113 (5.6%), and secondary LAST in 31 cases (1.5%). The Stingray system was used in 905 cases (45.2%), subintimal tracking and re-entry (STAR) in 333 cases (16.6%), and contrast-guided STAR in 29 cases (1.4%). The mean patient age was 64.2 ± 10 years, 86% were men, and 34.9% had prior coronary artery bypass graft surgery. Cases in which LAST was used were less complex with a lower J-CTO score (2.50 ± 1.32 vs. 2.95 ± 1.10, P \u3c 0.001). There was no difference in technical (75.0% vs 78.4%, P = 0.337) and procedural success (72.2% vs 75.5%, P = 0.384) and major cardiac adverse events (MACEs) (2.08% vs 3.55%, P = 0.352) between LAST and non-LAST cases. However, cases in which the LAST technique was used required less procedure and fluoroscopy time (Figure 1A). A primary LAST technique was associated with higher technical and procedural success rates and a similar MACE rate compared with a secondary LAST technique (Figure 1B).
Conclusion: LAST is used in 7.2% of ADR CTO PCI cases and is associated with similar technical and procedural success rates and major complication rates but lower procedural and fluoroscopy time compared with ADR cases that did not use LAST
