We performed a comparative analysis of antegrade dissection and re-entry CTO PCIs from the PROGRESS-CTO registry from 50 centers (2012−2024). Three dissection strategies were compared: (a) knuckle wiring: knuckle wire(s) without Carlino technique or CrossBoss catheter; (b) the CrossBoss technique: use of the CrossBoss catheter; and (c) the Carlino technique: use of the Carlino technique. In-stent CTO PCIs were excluded from the analysis.

Results

In total, 1575 (74.6%) cases used knuckle wiring, 427 (20.2%) the CrossBoss, and 110 (5.2%) the Carlino technique. Knuckle wiring was the most frequent strategy with increasing utilization over time (p < 0.001). The CrossBoss catheter was more common in lesions with lower J-CTO scores (CrossBoss: 2.91 vs. Knuckle wiring: 3.07 vs. Carlino: 3.18; p = 0.015), and was associated with higher technical success (CrossBoss: 84.0% vs. Knuckle wiring: 74.2% vs. Carlino: 64.2%; p < 0.001) and similar major adverse cardiac events rates, but lower perforation rates. Time to crossing was longer when Carlino was used (CrossBoss: 93 [70, 133] min vs. Knuckle wiring: 97 [63, 136] min vs. Carlino: 133 [84, 166] min, p = 0.001). Use of different types of knuckle wires (Pilot 200, Gladius Mongo, and Fielder XT) was associated with similar success rates.

Conclusions

Knuckle wiring is the most commonly used antegrade dissection strategy. The CrossBoss catheter was used in less complex cases and was associated with higher success, whereas the opposite was true for the Carlino technique.

Conflicts of Interest

Dr. Lorenzo Azzalini received consulting fees from Teleflex, Abiomed, GE Healthcare, Reflow Medical, Shockwave, and Cardiovascular Systems Inc.; received a research grant by Abiomed; serves on the advisory board of Abiomed and GE Healthcare; and owns equity in Reflow Medical. Dr. Emmanouil S. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), Cordis, CSI, Elsevier, GE Healthcare, Haemonetics, IMDS, Medtronic, SIS Medical, Teleflex, and Orbus Neich; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: LifeLens Technologies Inc., MHI Ventures, Cleerly Health, Stallion Medical, TrueVue Inc. Dr. Yader Sandoval: Abbott (consultant, advisory board), Roche Diagnostics (consultant, advisory board, speaker), Philips (consultant, advisory board, speaker), Zoll (advisory board), GE Healthcare (consultant, advisory board), CathWorks (consultant), HeartFlow (speaker), Cleerly (speaker, research grant). He is an associate editor for JACC Advances. He and others hold patent 20210401347. The other authors declare no conflicts of interest.

Open Research

Data Availability Statement

The authors have nothing to report.

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Volume106, Issue1

July 1, 2025

Pages 540-549

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Dissection Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention

ABSTRACT

Background

Aims

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

References

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Dissection Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention

ABSTRACT

Background

Aims

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

References

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