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 journalArticlepeer-review

16 Scopus citations


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 languageEnglish (US)
Pages (from-to)517-526
Number of pages10
JournalJACC: Cardiovascular Interventions
Issue number4
StatePublished - Feb 24 2020


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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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