Technical and procedural outcomes of the retrograde approach to chronic total occlusion interventions

Peter Tajti, Iosif Xenogiannis, Fotis Gargoulas, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Mitul Patel, M. Nicholas Burke, Santiago Garcia, Oleg Krestyaninov, Michalis Koutouzis, Wissam Jaber, Emmanouil S. Brilakis, Robert W. Yeh, Hector Tamez, Ehtisham Mahmud, James W. Choi, Dmitrii Khelimskii, Jaikirshan J. Khatri, Ioannis TsiafoutisAnthony H. Doing, Phil Dattilo, Catalin Toma, Barry F. Uretsky, Habib Samady, Brian Jefferson, Taral Patel, Srinivasa Potluri, David Kandzari, R. Michael Wyman, Shuaib Abdullah, Subhash Banerjee, Jeffrey Moses, Nicholas Lembo, Manish Parikh, Ajay Kirtane, Ziad A. Ali, Juan J. Russo, Emad Hakemi, Bavana Venkata Rangan, Imre Ungi

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Aims: The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement. Methods and results: We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001). Conclusions: In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications. Clinical Trial Registration: NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).

Original languageEnglish (US)
Pages (from-to)E891-E899
Issue number11
StatePublished - Dec 2020


  • Chronic coronary total occlusion
  • Other techniques
  • Stable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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