Retrograde percutaneous recanalization of coronary chronic total occlusions: outcomes from 17 patients

Given their suboptimal success rates, coronary chronic total occlusions (CTO) represent one of the last challenges of percutaneous coronary intervention (PCI). Among several novel techniques, the retrograde approach is one of the most promising, but it is still incompletely described. We report our 5-year experience in retrograde PCI for CTOs. We abstracted patient and procedural data on all cases with attempted retrograde approach. End-points were technical and procedural success, plus long-term major adverse cardiovascular events (MACE). The retrograde approach was used in 17 patients, with procedural success in 12 (71%), including 9 CTOs of right coronary, 2 of left circumflex, and 2 of left main arteries. Conversely, 4 cases of technical failure and 1 post-procedural myocardial infarction in an otherwise angiographically successful procedure were found. Causes of retrograde failure were: inability to deliver the balloon through the chosen collateral in 2 cases, inability to retrogradely cross the distal stump with the wire in 1 case, and interruption of the procedure due to rupture of a minor septal collateral branch during attempts at advancing the non-inflated balloon in 1 case. In all patients with retrograde failure, subsequent antegrade attempts could be carried out, with ultimate success in everybody. Follow-up at 24+/-21 months showed an overall MACE rate of 23%. In conclusion, the retrograde approach appears feasible and safe, and its application can be envisioned as a promising alternative strategy in selected patients in whom antegrade approaches fail or are deemed unsafe.