{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:30:31Z","timestamp":1783521031334,"version":"3.55.0"},"reference-count":7,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The primary retrograde approach is an established strategy for chronic total occlusion (CTO), yet the optimal direction of wire advancement after successful channel crossing has not been systematically evaluated. In long CTOs, knuckle wiring and R\u2010CART often facilitate lesion crossing, whereas in short CTOs, hematoma extension and limited R\u2010CART points often hinder lesion crossing. We developed a novel algorithm for CTOs &lt;\u200920\u2009mm and validated it using the Japanese CTO Expert Registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to validate an algorithm for wire crossing after establishing the primary retrograde approach in short CTOs (&lt;\u200920\u2009mm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Registry data from 2014 to 2022 were analyzed. Among patients with CTOs &lt;\u200920\u2009mm treated by a primary retrograde approach with successful channel crossing, we excluded ostial CTOs, in\u2010stent occlusions, tandem CTOs, unanalyzable caps, and anomalous origins, yielding 334 cases. Because the algorithm's first step states that \u201cif both caps are tapered, either direction is acceptable,\u201d 130 such cases were excluded. The remaining 204 patients were classified as Algorithm\u2010adherent or Algorithm\u2010deviation. All lesion characteristics, exclusion criteria, and outcomes were adjudicated by an independent core laboratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Lesion guidewire manipulation time was significantly shorter in the Algorithm\u2010adherent group (76.2\u2009\u00b1\u200948.9 vs. 123.2\u2009\u00b1\u200955.5\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Total procedural time was also shorter in the Algorithm\u2010adherent group (153.3\u2009\u00b1\u200964.2 vs. 205.0\u2009\u00b1\u200969.5\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), while procedural success rates were comparable between the two groups (99.2% vs. 95.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13). These findings remained consistent after propensity score matching. No significant differences were observed in contrast volume or complication rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The proposed algorithm for primary retrograde crossing of short CTOs was associated with shorter lesion guidewire manipulation and total procedural time, without compromising procedural success or safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70374","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T09:36:03Z","timestamp":1764236163000},"page":"529-540","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anatomy\u2010Based Algorithm to Optimize Wiring Strategy After Primary Retrograde Approach in Short Chronic Total Occlusions"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5743-6742","authenticated-orcid":false,"given":"Hidenari","family":"Matsumura","sequence":"first","affiliation":[{"name":"Department of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichiro","family":"Shimoji","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2024.02.040"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4244\/AIJ-D-19-00028"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-17-00867"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.09.024"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.055"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.68.1088"},{"issue":"7","key":"e_1_2_9_8_1","first-page":"334","article-title":"New Concept for CTO Recanalization Using Controlled Antegrade and Retrograde Subintimal Tracking: The CART Technique","volume":"18","author":"Surmely J. F.","year":"2006","journal-title":"Journal of Invasive Cardiology"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70374","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70374","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70374","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:49:46Z","timestamp":1773060586000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":7,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/ccd.70374"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70374","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"assertion":[{"value":"2025-09-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}