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Published on: July 21, 2013
Retrograde crossing for chronic total occlusion lesions: the Japanese way
Masamichi Takano1, Kyoichi Mizuno
1Division of Cardiology, Nippon Medical School, Tokyo, Japan. takanom@nms.ac.jp
Insights
The retrograde approach offers a novel strategy for recanalizing chronic total occlusion (CTO) lesions during percutaneous coronary intervention (PCI). This method utilizes collateral vessels or bypass grafts to access CTO lesions, enhancing procedural success rates.
Area of Science:
- Interventional Cardiology
- Vascular Biology
- Medical Devices
Background:
- Chronic total occlusion (CTO) lesions present a significant challenge in percutaneous coronary intervention (PCI).
- The antegrade approach, advancing guidewires from proximal arteries, is the conventional method for CTO treatment.
- Limitations of the antegrade approach necessitate alternative strategies for successful CTO recanalization.
Purpose of the Study:
- To introduce and describe a retrograde approach for percutaneous coronary intervention (PCI) in treating chronic total occlusion (CTO) lesions.
- To present techniques and strategies developed for the retrograde approach in CTO recanalization.
- To provide a method for achieving CTO lesion recanalization via a retrograde pathway.
Main Methods:
- Utilizing collateral vessels or coronary artery bypass grafts to access the distal end of CTO lesions.
- Employing specialized PCI devices, including guidewires and balloons, via the retrograde route.
- Developing and refining techniques for navigating CTO lesions from the distal to proximal direction.
Main Results:
- Successful recanalization of CTO lesions using the retrograde approach has been demonstrated.
- The retrograde approach facilitates the delivery of PCI devices to challenging CTO lesions.
- This strategy offers an alternative pathway for interventional cardiologists when antegrade approaches are unsuccessful.
Conclusions:
- The retrograde approach is a viable and effective strategy for percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lesions.
- Further development and acceptance of retrograde techniques can improve procedural success rates in complex CTO cases.
- This article details a method for CTO recanalization, expanding treatment options for interventional cardiologists.
Abstract:
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions remains one of the major challenges in the field of interventional cardiology. Crossing guidewires through the CTO lesions has been conventionally performed from the proximal arteries to the lesions as an antegrade approach. To date, a retrograde approach, to penetrate PCI devices including guidewires and balloons into the distal end of CTO lesions via collateral vessels or coronary artery bypass grafts, has been attempted in order to achieve procedural success. With introduction of the retrograde approach for treatments of CTO lesions, several kinds of devices, techniques, and strategies have been developed. Although the techniques and strategies for the retrograde approach have not been worldwide accepted to interventional cardiologists, we introduce a way to obtain recanalization of the CTO lesions using the retrograde approach in this article.
