Retrograde CTO PCI of native coronary arteries via left internal mammary artery grafts: Insights from a multicenter US registry
Tajti P, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh R, Patel M, Mahmud E, Choi J, Burke N, Doing A, Toma C, Uretsky B, Holper E, Wyman RM, Lombardi W, Kandzari D, Lembo N, Garcia S, Krestyaninov O, Khelimskii D, Koutouzis M, Tsiafoutis I, Moses J, Kirtane AJ, Parikh M, Ali Z, Hatem R, Karatasakis A, Karacsonyi J, Danek BA, Rangan B, Brilakis E. Retrograde CTO PCI of native coronary arteries via left internal mammary artery grafts: Insights from a multicenter US registry. J Am Coll Cardiol. 2017;70(18):B189.
J Am Coll Cardiol
BACKGROUND Retrograde percutaneous interventions (PCI) of native coronary artery chronic total occlusions (CTOs) via left internal mammaryartery (LIMA) grafts have received limited study. METHODS We compared the clinical and procedural characteristics and outcomes of retrograde CTO PCIthrough LIMA grafts vs. via other vessels in acontemporary multicenter registry. RESULTS The LIMA was used as collateral channel in 20 of 990 retrograde CTO PCIs (2.0%) performed at 18 USCenters. The mean age of the study patients was 69±7 years, and 95% were men. The most common CTO target vessel was the right coronary artery (55%). The mean J-CTO score in the LIMA group was high (3.45±0.76). The technical and procedural success rate of retrograde PCI via LIMA grafts was 70% and 70%, respectively, vs. 81.0% and 78.2% (p=0.247, and p=0.412), respectively for retrograde via other conduits (Figure). The incidence of major in-hospital complications was also similar between the LIMA and non- LIMA retrograde groups (5% vs. 6%, p=1.000). Use of guide catheter extensions (40% vs. 28%, p=0.217), intravascular ultrasound (45% vs. 31%, p=0.197), and left ventricular assist devices (24% vs. 10%, p=0.769) were numerically higher in retrogradeCTO PCIs via LIMA grafts. CONCLUSION RetrogradeCTO PCI is infrequently performed via LIMA graftsand is associated with numerically lower success but similar major in-hospital complication rates as retrograde CTO PCI performed via other vessels. (Figure presented).