TY - JOUR
T1 - The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions
T2 - Technical Analysis and Procedural Outcomes
AU - Allana, Salman S.
AU - Kostantinis, Spyridon
AU - Rempakos, Athanasios
AU - Simsek, Bahadir
AU - Karacsonyi, Judit
AU - Alexandrou, Michaella
AU - Choi, James W.
AU - Alaswad, Khaldoon
AU - Krestyaninov, Oleg
AU - Khelimskii, Dmitrii
AU - Gorgulu, Sevket
AU - Davies, Rhian
AU - Benton, Stewart
AU - Karmpaliotis, Dimitrios
AU - Jaffer, Farouc A.
AU - Khatri, Jaikirshan J.
AU - Poommipanit, Paul
AU - Azzalini, Lorenzo
AU - Kearney, Kathleen
AU - Chandwaney, Raj
AU - Nicholson, William
AU - Jaber, Wissam
AU - Rinfret, Stephane
AU - Frizzell, Jarrod
AU - Patel, Taral
AU - Jefferson, Brian
AU - Aygul, Nazif
AU - Rangan, Bavana V.
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/11/27
Y1 - 2023/11/27
N2 - Background: Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher complication rates when compared with the antegrade approach. Objectives: This study sought to assess contemporary techniques and outcomes of retrograde CTO PCI. Methods: We examined the baseline characteristics, procedural techniques and outcomes of 4,058 retrograde CTO PCIs performed at 44 centers between 2012 and 2023. Major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, and stroke. Results: The average J-CTO (Multicenter CTO Registry in Japan) score was 3.1 ± 1.1. Retrograde crossing was successful in 60.5% and lesion crossing in 81.6% of cases. The collaterals pathways successfully used were septals in 62.0%, saphenous vein grafts in 17.4%, and epicardials in 19.1%. The technical and procedural success rates were 78.7% and 76.6%, respectively. When retrograde crossing failed, technical success was achieved in 50.3% of cases using the antegrade approach. In-hospital MACE was 3.5%. The clinical coronary perforation rate was 5.8%. The incidence of in-hospital MACE with retrograde true lumen crossing, just marker antegrade crossing, conventional reverse controlled antegrade and retrograde tracking (CART), contemporary reverse CART, extended reverse CART, guide-extension reverse CART, and CART was 2.1%, 0.8%, 5.5%, 3.0%, 2.1%, 3.2%, and 4.1%, respectively; P = 0.01). Conclusions: Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest. There is need for improvement of the efficacy and safety of retrograde CTO PCI.
AB - Background: Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher complication rates when compared with the antegrade approach. Objectives: This study sought to assess contemporary techniques and outcomes of retrograde CTO PCI. Methods: We examined the baseline characteristics, procedural techniques and outcomes of 4,058 retrograde CTO PCIs performed at 44 centers between 2012 and 2023. Major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, and stroke. Results: The average J-CTO (Multicenter CTO Registry in Japan) score was 3.1 ± 1.1. Retrograde crossing was successful in 60.5% and lesion crossing in 81.6% of cases. The collaterals pathways successfully used were septals in 62.0%, saphenous vein grafts in 17.4%, and epicardials in 19.1%. The technical and procedural success rates were 78.7% and 76.6%, respectively. When retrograde crossing failed, technical success was achieved in 50.3% of cases using the antegrade approach. In-hospital MACE was 3.5%. The clinical coronary perforation rate was 5.8%. The incidence of in-hospital MACE with retrograde true lumen crossing, just marker antegrade crossing, conventional reverse controlled antegrade and retrograde tracking (CART), contemporary reverse CART, extended reverse CART, guide-extension reverse CART, and CART was 2.1%, 0.8%, 5.5%, 3.0%, 2.1%, 3.2%, and 4.1%, respectively; P = 0.01). Conclusions: Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest. There is need for improvement of the efficacy and safety of retrograde CTO PCI.
KW - coronary artery disease
KW - coronary chronic total occlusion
KW - percutaneous coronary intervention
KW - retrograde
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U2 - 10.1016/j.jcin.2023.08.031
DO - 10.1016/j.jcin.2023.08.031
M3 - Article
C2 - 38030360
AN - SCOPUS:85176401337
SN - 1936-8798
VL - 16
SP - 2748
EP - 2762
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 22
ER -