Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Cardiol


Background: An upfront (primary) retrograde strategy is often used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods: We examined the clinical, angiographic characteristics, and procedural outcomes of CTO PCIs that were approached with a primary retrograde strategy in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO; NCT02061436). Interventional collaterals were defined as collaterals that appeared suitable for retrograde CTO PCI.

Results: Of 10,286 CTO PCIs, a primary retrograde strategy was used in 1,329 (13%) with an initial technical success of 66% and a final success of 83% with subsequent strategies. Successful vs unsuccessful primary retrograde cases had similar baseline characteristics with high prior coronary artery bypass graft surgery (52% vs 53%, P = 0.682), respectively. The PROGRESS-CTO score (1.3 ± 0.9 vs 1.6 ± 0.9, P < 0.001), air kerma radiation (3.9 ± 2.8 vs 3.4 ± 2.6 Gray, P = 0.013), and contrast (294 ± 148 mL vs 248 ± 128 mL, P < 0.001) were higher in the unsuccessful group, whereas the presence of interventional collaterals (95% vs 72%, P < 0.001) and Werner collateral connection grade 2 (43% vs 31%, P < 0.001) were higher in the successful group. On multivariable logistic regression analysis, the only variable associated with a successful primary retrograde strategy was the presence of interventional collaterals: odds ratio 6.52, 95% confidence interval 3.5-12.1, P < 0.001.

Conclusion: Presence of interventional collaterals is independently associated with higher success rates with a primary retrograde strategy in CTO PCI.

Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)





First Page


Last Page




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.