Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Cardiol


Background: The retrograde approach to coronary chronic total occlusions (CTOs) can be used as the initial crossing strategy (primary retrograde) or after failure of antegrade crossing attempts (secondary retrograde).

Methods: We compared baseline clinical and angiographic characteristics and procedural outcomes of primary versus secondary retrograde crossing for CTO percutaneous coronary intervention (PCI) among 2,789 procedures performed at 34 centers between 2012 and 2021.

Results: Retrograde CTO PCI was performed as the primary crossing strategy in 1,086 cases (38.9%) and as a secondary approach in 1,703 cases (61.1%). Patients in the primary group had slightly lower left ventricular ejection fraction (49.1% vs 50.4%; P = 0.018), were more likely to have had previous coronary artery bypass graft surgery (52.9% vs 38.4%; P < 0.001) and had higher J-CTO (3.31 ± 0.98 vs 2.99 ± 1.09; P < 0.001) and PROGRESS-CTO (1.47 ± 0.92 vs 1.29 ± 0.99; P < 0.001) scores. Technical (81.4% vs 77.3%; P = 0.01) and procedural (78.6% vs 74.1%; P = 0.006) success rates were higher in the primary retrograde group, with no difference in in-hospital major adverse events (4.3% vs 4.0%; P = 0.66). Contrast volume (250 [176,347] mL vs 270[190,367] mL; P < 0.001) and procedure time (175 [127,233] min vs 180 [142,236] min; P < 0.001) were lower in the primary group.

Conclusion: Use of retrograde approach as primary crossing strategy is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with secondary retrograde CTO PCI.





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