The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes
Recommended Citation
Allana SS, Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Alaswad K, Krestyaninov O, Khelimskii D, Gorgulu S, Davies R, Benton S, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Azzalini L, Kearney K, Chandwaney R, Nicholson W, Jaber W, Rinfret S, Frizzell J, Patel T, Jefferson B, Aygul N, Rangan BV, and Brilakis ES. The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes. JACC Cardiovasc Interv 2023; 16(22):2748-2762.
Document Type
Article
Publication Date
11-27-2023
Publication Title
JACC Cardiovasc Interv
Abstract
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.
Medical Subject Headings
Humans; Percutaneous Coronary Intervention; Treatment Outcome; Coronary Occlusion; Chronic Disease; Coronary Angiography; Registries; Risk Factors
PubMed ID
38030360
Volume
16
Issue
22
First Page
2748
Last Page
2762
