Antegrade versus Retrograde Techniques for Chronic Total Occlusions (CTO): A Review and Comparison of Techniques and Outcomes

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Expert review of cardiovascular therapy


Introduction: As the field of chronic total occlusion percutaneous coronary intervention has evolved, technical approaches have evolved and been refined.

Areas Covered: In this review, we discuss the major techniques utilized in modern CTO PCI including antegrade wiring, antegrade dissection re-entry, retrograde wiring, and retrograde dissection re-entry. Retrograde techniques have been extensively studied in comparison to antegrade techniques. Retrograde techniques have contributed to increases in CTO PCI success rates and are generally used in higher complexity lesions. Observational data suggests increased short term complications in procedures requiring the use of retrograde techniques however long term CTO PCI durability and patient outcomes have been shown to be similar among procedures using antegrade only versus retrograde techniques.

Expert Opinion: Retrograde techniques play a vital role in the technical success of CTO PCI, particularly among more complex lesions and in patients with high burdens of comorbidities. Increases in procedural safety with equipment iteration and in the use of adjunctive imaging will play an important role in the selection of appropriate retrograde conduits and the overall success rates of CTO PCI.

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ePub ahead of print