BACKGROUND: Most attempts to intervene on coronary chronic total occlusions fail because the wire cannot cross the occlusion. Three main strategies can be used to cross a CTO: antegrade wire escalation, antegrade dissection/re-entry and retrograde. The basic underlying principle of the hybrid approach (HA) is that no single procedural crossing strategy should be pursued to exhaustion, but an alternative strategy should be attempted if a given crossing strategy does not progress.

METHODS: The success rates, complication rates, procedural characteristics and clinical outcomes of 72 consecutive CTO-PCIs with single crossing strategy (control group) were compared to 34 cases of hybrid approach to CTO-PCI (study group). In the study group, successful crossing strategy was assessed. The SYNTAX and J-CTO scores were assessed to evaluate the potential severity of the procedure. The complications included MACCE and the procedural complications. At 6-month follow-up, clinical outcomes including target vessel revascularization (TVR), target lesions revascularization (TLR) and major adverse cardiac events (MACE) were evaluated.

RESULTS: Procedural success was achieved in 91.2% cases in HA group and was significantly higher than cases in control group (86.1% respectively). The final successful CTO crossing strategy in HA group was antegrade in 48.4%, retrograde in 29%, and antegrade dissection/reentry in 22.6%. The retrograde approach in control group was used in 45.8% cases with 87.9% procedural success. Major procedural complications occurred 2.9% and 2.8% respectively, with no statistically significant difference.

CONCLUSION: Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to other CTOs crossing strategies. High success rates for CTO interventions can be achieved without incurring more complications.

Keywords: CTO-PCI, hybrid approach