Extraplaque versus intraplaque tracking in chronic total occlusion percutaneous coronary intervention

Catheter Cardiovasc Interv. 2022 Nov;100(6):1021-1029. doi: 10.1002/ccd.30403. Epub 2022 Sep 28.


Objective: To compare the clinical outcomes after extraplaque (EP) versus intraplaque (IP) tracking in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Background: The impact of modern dissection and reentry (DR) techniques on the long-term outcomes of CTO PCI remains controversial.

Methods: We performed a systematic review and meta-analysis of studies that compared EP versus IP tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) are calculated using the Der-Simonian and Laird random-effects method.

Results: Our meta-analysis included seven observational studies with 2982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO score, longer lesion length, and more severe calcification and had significantly longer stented segments. During a median follow-up of 12 months (range 9-12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI (1.10-2.06), p = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI (1.15-2.48), p = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI (0.67-2.78), p = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI (0.82-2.69), p = 0.20), stent thrombosis (OR 2.09, 95% CI (0.69-6.33), p = 0.19), or cardiac death (OR 1.10, 95% CI (0.39-3.15), p = 0.85) between IP and EP tracking.

Conclusion: EP tracking is utilized in more complex CTOs and requires more stents. EP tracking is associated with a higher risk of MACE, driven by a higher risk of TVR at 1 year, but without an increased risk of death or MI compared with IP tracking. EP tracking is critically important for contemporary CTO PCI.

Keywords: RDR; antegrade dissection and reentry (ADR); chronic total occlusion (CTO); extraplaque; intraplaque; percutaneous coronary intervention.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Chronic Disease
  • Coronary Angiography / adverse effects
  • Coronary Occlusion* / complications
  • Coronary Occlusion* / diagnostic imaging
  • Coronary Occlusion* / therapy
  • Humans
  • Myocardial Infarction* / etiology
  • Observational Studies as Topic
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Risk Factors
  • Time Factors
  • Treatment Outcome