The impact of dissection and re-entry versus wire escalation techniques on long-term clinical outcomes in patients with chronic total occlusion lesions following percutaneous coronary intervention: An updated meta-analysis

BACKGROUND: The meta-analysis was performed to evaluate the effect of dissection and re-entry (DR) vs. wire escalation (WE) techniques on long-term clinical outcomes in patients with chronic total occlusion (CTO) lesions undergoing percutaneous coronary intervention. METHODS: Studies were searched in electronic databases from inception to September, 2019. Results were pooled using random effects model and fixed effects model and are presented as risk ratios (RR) with 95% confidence intervals (CI). RESULTS: Pooled analyses revealed that patients with DR techniques had overall higher complexity CTO lesions than patients with WE techniques and required a greater number of stents and a greater mean stent length. The “extensive” DR techniques may have a higher incidence of target vessel revascularization (TVR) (RR = 2.30, 95% CI: 1.77–2.98), in-stent restenosis (RR = 1.71, 95% CI: 1.30–2.23), in-stent reocclusion (RR = 1.86, 95% CI: 1.03–3.3) and death/myocardial infarction/TVR (RR = 2.10, 95% CI: 1.71–2.58), when compared with WE techniques, during the long-term follow-up. However, “limited” DR techniques result in more promising outcomes, and are comparable to conventional WE techniques. CONCLUSIONS: Dissection and re-entry techniques were associated with increased risk of long-term negative clinical events, especially “extensive” DR techniques. However, “limited” DR techniques resulted in good long-term outcomes, comparable to WE techniques.