Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft

Iosif Xenogiannis; Fotis Gkargkoulas; Dimitri Karmpaliotis; Oleg Krestyaninov; Dmitrii Khelimskii; Farouc A. Jaffer; Jaikirshan J. Khatri; David E. Kandzari; R. Michael Wyman; Anthony H. Doing; Phil Dattilo; Catalin Toma; Robert W. Yeh; Hector Tamez; James W. Choi; Wissam Jaber; Habib Samady; Abdul M. Sheikh; Srinivasa Potluri; Mitul Patel; Ehtisham Mahmud; Basem Elbaruni; Michael P. Love; Michalis Koutouzis; Ioannis Tsiafoutis; Brian K. Jefferson; Taral Patel; Barry Uretsky; Jeffrey W. Moses; Nicholas J. Lembo; Manish Parikh; Ajay J. Kirtane; Ziad A. Ali; Allison B. Hall; Michael S. Megaly; Evangelia Vemmou; Ilias Nikolakopoulos; Bavana Venkata Rangan; Pamela W. Morley; Bassel Bou Dargham; Shuaib Abdullah; Santiago Garcia; Subhash Banerjee; M. Nicholas Burke; Emmanouil S. Brilakis; Khaldoon Alaswad

doi:10.1016/j.jcin.2019.10.028

Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft

Iosif Xenogiannis, Fotis Gkargkoulas, Dimitri Karmpaliotis, Oleg Krestyaninov, Dmitrii Khelimskii, Farouc A. Jaffer, Jaikirshan J. Khatri, David E. Kandzari, R. Michael Wyman, Anthony H. Doing, Phil Dattilo, Catalin Toma, Robert W. Yeh, Hector Tamez, James W. Choi, Wissam Jaber, Habib Samady, Abdul M. Sheikh, Srinivasa Potluri, Mitul PatelEhtisham Mahmud, Basem Elbaruni, Michael P. Love, Michalis Koutouzis, Ioannis Tsiafoutis, Brian K. Jefferson, Taral Patel, Barry Uretsky, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Allison B. Hall, Michael S. Megaly, Evangelia Vemmou, Ilias Nikolakopoulos, Bavana Venkata Rangan, Pamela W. Morley, Bassel Bou Dargham, Shuaib Abdullah, Santiago Garcia, Subhash Banerjee, M. Nicholas Burke, Emmanouil S. Brilakis, Khaldoon Alaswad

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Objectives: The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The use of SVGs for retrograde crossing during CTO PCI has received limited study. Methods: A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). Results: Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01). Conclusions: Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.

Original language	English (US)
Pages (from-to)	517-526
Number of pages	10
Journal	JACC: Cardiovascular Interventions
Volume	13
Issue number	4
DOIs	https://doi.org/10.1016/j.jcin.2019.10.028
State	Published - Feb 24 2020

Keywords

chronic total occlusion
collateral
percutaneous coronary interventions
retrograde approach
saphenous vein grafts

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcin.2019.10.028

Cite this

Xenogiannis, I., Gkargkoulas, F., Karmpaliotis, D., Krestyaninov, O., Khelimskii, D., Jaffer, F. A., Khatri, J. J., Kandzari, D. E., Wyman, R. M., Doing, A. H., Dattilo, P., Toma, C., Yeh, R. W., Tamez, H., Choi, J. W., Jaber, W., Samady, H., Sheikh, A. M., Potluri, S., ... Alaswad, K. (2020). Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft. JACC: Cardiovascular Interventions, 13(4), 517-526. https://doi.org/10.1016/j.jcin.2019.10.028

Xenogiannis, I, Gkargkoulas, F, Karmpaliotis, D, Krestyaninov, O, Khelimskii, D, Jaffer, FA, Khatri, JJ, Kandzari, DE, Wyman, RM, Doing, AH, Dattilo, P, Toma, C, Yeh, RW, Tamez, H, Choi, JW, Jaber, W, Samady, H, Sheikh, AM, Potluri, S, Patel, M, Mahmud, E, Elbaruni, B, Love, MP, Koutouzis, M, Tsiafoutis, I, Jefferson, BK, Patel, T, Uretsky, B, Moses, JW, Lembo, NJ, Parikh, M, Kirtane, AJ, Ali, ZA, Hall, AB, Megaly, MS, Vemmou, E, Nikolakopoulos, I, Rangan, BV, Morley, PW, Bou Dargham, B, Abdullah, S, Garcia, S, Banerjee, S, Burke, MN, Brilakis, ES & Alaswad, K 2020, 'Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft', JACC: Cardiovascular Interventions, vol. 13, no. 4, pp. 517-526. https://doi.org/10.1016/j.jcin.2019.10.028

@article{2fad3f9d97e14be8b438f67ddbc02baf,

title = "Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft",

abstract = "Objectives: The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The use of SVGs for retrograde crossing during CTO PCI has received limited study. Methods: A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). Results: Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01). Conclusions: Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.",

keywords = "chronic total occlusion, collateral, percutaneous coronary interventions, retrograde approach, saphenous vein grafts",

author = "Iosif Xenogiannis and Fotis Gkargkoulas and Dimitri Karmpaliotis and Oleg Krestyaninov and Dmitrii Khelimskii and Jaffer, {Farouc A.} and Khatri, {Jaikirshan J.} and Kandzari, {David E.} and Wyman, {R. Michael} and Doing, {Anthony H.} and Phil Dattilo and Catalin Toma and Yeh, {Robert W.} and Hector Tamez and Choi, {James W.} and Wissam Jaber and Habib Samady and Sheikh, {Abdul M.} and Srinivasa Potluri and Mitul Patel and Ehtisham Mahmud and Basem Elbaruni and Love, {Michael P.} and Michalis Koutouzis and Ioannis Tsiafoutis and Jefferson, {Brian K.} and Taral Patel and Barry Uretsky and Moses, {Jeffrey W.} and Lembo, {Nicholas J.} and Manish Parikh and Kirtane, {Ajay J.} and Ali, {Ziad A.} and Hall, {Allison B.} and Megaly, {Michael S.} and Evangelia Vemmou and Ilias Nikolakopoulos and Rangan, {Bavana Venkata} and Morley, {Pamela W.} and {Bou Dargham}, Bassel and Shuaib Abdullah and Santiago Garcia and Subhash Banerjee and Burke, {M. Nicholas} and Brilakis, {Emmanouil S.} and Khaldoon Alaswad",

note = "Funding Information: The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Jaffer is a consultant for Abbott Vascular, Boston Scientific, and Siemens; and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Khatri has received honoraria from Asahi Intecc; and is a speaker and proctor for Abbott Vascular. Dr. Kandzari has received research grants from Boston Scientific, Medtronic Cardiovascular, and Abbott; and is a consultant or advisory board member for Boston Scientific and Medtronic Cardiovascular. Dr. Wyman is a member of the Speakers Bureau for Boston Scientific, Abbott Vascular, and Asahi; has received honoraria from Boston Scientific, Abbott Vascular, and Asahi; and is a consultant or advisory board member for Boston Scientific, Abbott Vascular, and Asahi. Dr. Toma is a consultant for Abbott and Volcano Phillips. Dr. Yeh has received a career development award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. M. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; has received speaking fees from Medtronic, Corindus, and Abbott Vascular; has received educational program fees from Abbott Vascular; and has received clinical events committee fees from St. Jude. Dr. Jefferson has received honoraria and consulting and speaking fees from Abbott, Boston Scientific, Cardiovascular Systems, Inc., and Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic; and is a consultant or advisory board member for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureau for Abbott Vascular, Medtronic, Cardiovascular Systems, Inc., Boston Scientific, and Trireme; and is an advisory board member for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca; has ownership interest, partnership, and principal in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from Infraredx and The Spectranetics Corporation. Dr. Garcia has received consulting fees from Medtronic. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership interest in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, Amgen, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (board of directors), Cardiovascular Systems, Inc., Elsevier, Infraredx, GE Healthcare, Siemens, Teleflex, and Medtronic; has received research support from Siemens and Regeneron and is a shareholder in MHI Ventures. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and is a consultant (no financial compensation) for Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at the Minneapolis Heart Institute Foundation. REDCap is a secure, web-based application designed to support data capture for research studies, providing: 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources. The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Jaffer is a consultant for Abbott Vascular, Boston Scientific, and Siemens; and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Khatri has received honoraria from Asahi Intecc; and is a speaker and proctor for Abbott Vascular. Dr. Kandzari has received research grants from Boston Scientific, Medtronic Cardiovascular, and Abbott; and is a consultant or advisory board member for Boston Scientific and Medtronic Cardiovascular. Dr. Wyman is a member of the Speakers Bureau for Boston Scientific, Abbott Vascular, and Asahi; has received honoraria from Boston Scientific, Abbott Vascular, and Asahi; and is a consultant or advisory board member for Boston Scientific, Abbott Vascular, and Asahi. Dr. Toma is a consultant for Abbott and Volcano Phillips. Dr. Yeh has received a career development award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. M. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; has received speaking fees from Medtronic, Corindus, and Abbott Vascular; has received educational program fees from Abbott Vascular; and has received clinical events committee fees from St. Jude. Dr. Jefferson has received honoraria and consulting and speaking fees from Abbott, Boston Scientific, Cardiovascular Systems, Inc., and Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic; and is a consultant or advisory board member for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureau for Abbott Vascular, Medtronic, Cardiovascular Systems, Inc., Boston Scientific, and Trireme; and is an advisory board member for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca; has ownership interest, partnership, and principal in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from Infraredx and The Spectranetics Corporation. Dr. Garcia has received consulting fees from Medtronic. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership interest in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, Amgen, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (board of directors), Cardiovascular Systems, Inc., Elsevier, Infraredx, GE Healthcare, Siemens, Teleflex, and Medtronic; has received research support from Siemens and Regeneron and is a shareholder in MHI Ventures. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and is a consultant (no financial compensation) for Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = feb,

day = "24",

doi = "10.1016/j.jcin.2019.10.028",

language = "English (US)",

volume = "13",

pages = "517--526",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "4",

}

TY - JOUR

T1 - Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft

AU - Xenogiannis, Iosif

AU - Gkargkoulas, Fotis

AU - Karmpaliotis, Dimitri

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Jaffer, Farouc A.

AU - Khatri, Jaikirshan J.

AU - Kandzari, David E.

AU - Wyman, R. Michael

AU - Doing, Anthony H.

AU - Dattilo, Phil

AU - Toma, Catalin

AU - Yeh, Robert W.

AU - Tamez, Hector

AU - Choi, James W.

AU - Jaber, Wissam

AU - Samady, Habib

AU - Sheikh, Abdul M.

AU - Potluri, Srinivasa

AU - Patel, Mitul

AU - Mahmud, Ehtisham

AU - Elbaruni, Basem

AU - Love, Michael P.

AU - Koutouzis, Michalis

AU - Tsiafoutis, Ioannis

AU - Jefferson, Brian K.

AU - Patel, Taral

AU - Uretsky, Barry

AU - Moses, Jeffrey W.

AU - Lembo, Nicholas J.

AU - Parikh, Manish

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Hall, Allison B.

AU - Megaly, Michael S.

AU - Vemmou, Evangelia

AU - Nikolakopoulos, Ilias

AU - Rangan, Bavana Venkata

AU - Morley, Pamela W.

AU - Bou Dargham, Bassel

AU - Abdullah, Shuaib

AU - Garcia, Santiago

AU - Banerjee, Subhash

AU - Burke, M. Nicholas

AU - Brilakis, Emmanouil S.

AU - Alaswad, Khaldoon

N1 - Funding Information: The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Jaffer is a consultant for Abbott Vascular, Boston Scientific, and Siemens; and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Khatri has received honoraria from Asahi Intecc; and is a speaker and proctor for Abbott Vascular. Dr. Kandzari has received research grants from Boston Scientific, Medtronic Cardiovascular, and Abbott; and is a consultant or advisory board member for Boston Scientific and Medtronic Cardiovascular. Dr. Wyman is a member of the Speakers Bureau for Boston Scientific, Abbott Vascular, and Asahi; has received honoraria from Boston Scientific, Abbott Vascular, and Asahi; and is a consultant or advisory board member for Boston Scientific, Abbott Vascular, and Asahi. Dr. Toma is a consultant for Abbott and Volcano Phillips. Dr. Yeh has received a career development award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. M. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; has received speaking fees from Medtronic, Corindus, and Abbott Vascular; has received educational program fees from Abbott Vascular; and has received clinical events committee fees from St. Jude. Dr. Jefferson has received honoraria and consulting and speaking fees from Abbott, Boston Scientific, Cardiovascular Systems, Inc., and Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic; and is a consultant or advisory board member for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureau for Abbott Vascular, Medtronic, Cardiovascular Systems, Inc., Boston Scientific, and Trireme; and is an advisory board member for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca; has ownership interest, partnership, and principal in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from Infraredx and The Spectranetics Corporation. Dr. Garcia has received consulting fees from Medtronic. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership interest in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, Amgen, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (board of directors), Cardiovascular Systems, Inc., Elsevier, Infraredx, GE Healthcare, Siemens, Teleflex, and Medtronic; has received research support from Siemens and Regeneron and is a shareholder in MHI Ventures. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and is a consultant (no financial compensation) for Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at the Minneapolis Heart Institute Foundation. REDCap is a secure, web-based application designed to support data capture for research studies, providing: 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources. The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Jaffer is a consultant for Abbott Vascular, Boston Scientific, and Siemens; and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Khatri has received honoraria from Asahi Intecc; and is a speaker and proctor for Abbott Vascular. Dr. Kandzari has received research grants from Boston Scientific, Medtronic Cardiovascular, and Abbott; and is a consultant or advisory board member for Boston Scientific and Medtronic Cardiovascular. Dr. Wyman is a member of the Speakers Bureau for Boston Scientific, Abbott Vascular, and Asahi; has received honoraria from Boston Scientific, Abbott Vascular, and Asahi; and is a consultant or advisory board member for Boston Scientific, Abbott Vascular, and Asahi. Dr. Toma is a consultant for Abbott and Volcano Phillips. Dr. Yeh has received a career development award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. M. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; has received speaking fees from Medtronic, Corindus, and Abbott Vascular; has received educational program fees from Abbott Vascular; and has received clinical events committee fees from St. Jude. Dr. Jefferson has received honoraria and consulting and speaking fees from Abbott, Boston Scientific, Cardiovascular Systems, Inc., and Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic; and is a consultant or advisory board member for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureau for Abbott Vascular, Medtronic, Cardiovascular Systems, Inc., Boston Scientific, and Trireme; and is an advisory board member for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca; has ownership interest, partnership, and principal in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from Infraredx and The Spectranetics Corporation. Dr. Garcia has received consulting fees from Medtronic. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership interest in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, Amgen, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (board of directors), Cardiovascular Systems, Inc., Elsevier, Infraredx, GE Healthcare, Siemens, Teleflex, and Medtronic; has received research support from Siemens and Regeneron and is a shareholder in MHI Ventures. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and is a consultant (no financial compensation) for Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2020 American College of Cardiology Foundation

PY - 2020/2/24

Y1 - 2020/2/24

N2 - Objectives: The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The use of SVGs for retrograde crossing during CTO PCI has received limited study. Methods: A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). Results: Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01). Conclusions: Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.

AB - Objectives: The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The use of SVGs for retrograde crossing during CTO PCI has received limited study. Methods: A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). Results: Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01). Conclusions: Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.

KW - chronic total occlusion

KW - collateral

KW - percutaneous coronary interventions

KW - retrograde approach

KW - saphenous vein grafts

UR - http://www.scopus.com/inward/record.url?scp=85079182218&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85079182218&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2019.10.028

DO - 10.1016/j.jcin.2019.10.028

M3 - Article

C2 - 32081243

AN - SCOPUS:85079182218

SN - 1936-8798

VL - 13

SP - 517

EP - 526

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 4

ER -

Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft

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