Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions via Saphenous Vein Grafts
Xenogiannis I, Gkargkoulas F, Karmpaliotis D, Krestyaninov O, Khelimskii D, Jaffer FA, Khatri J, Kandzari D, Wyman RM, Doing A, Toma C, Yeh R, Tamez H, Choi J, Jaber W, Samady H, Sheikh A, Potluri S, Patel M, Mahmud E, Elbaruni B, Tsiafoutis I, Jefferson B, Patel T, Uretsky B, Moses JW, Lembo N, Parikh M, Kirtane AJ, Ali Z, Megaly M, Vemmou E, Nikolakopoulos I, Rangan B, Morley P, Dargham BB, Abdullah S, Garcia S, Banerjee S, Brilakis E, and Alaswad K. Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions via Saphenous Vein Grafts. J Am Coll Cardiol 2019; 74(13):B660.
J Am Coll Cardiol
Background: The use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We examined 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers. We compared the clinical, angiographic, and technical characteristics and procedural outcomes among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). Results: Retrograde CTO PCI via SVGs was performed in 189 cases (12%) (Figure). Patients in the SVG group were older (70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) and higher PROGRESS-CTO scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Femoral access was used more often in the SVG group (88% vs. 82%; p = 0.04). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse cardiac events (MACE) (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01). [Figure presented] Conclusion: The use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital MACE compared with retrograde CTO PCI via other collateral types. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)