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Recanalisation of coronary chronic total occlusion by retrograde approach: the first experience in Poland
Leszek Bryniarski1, Sławomir Surowiec, Łukasz Klima
11st Department of Cardiology, Interventional Electrocardiology, and Arterial Hypertension, Jagiellonian University, Medical College, University Hospital, Krakow, Poland. l_bryniarski@poczta.fm.
Insights
The retrograde approach for coronary chronic total occlusion (CTO) revascularisation is safe and effective, achieving high success rates comparable to the antegrade approach. While it requires longer fluoroscopy times and more contrast, it offers a viable option for complex CTO cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The retrograde approach has enhanced the effectiveness of revascularisation procedures for coronary chronic total occlusion (CTO).
- Percutaneous coronary intervention (PCI) for CTO remains challenging, necessitating advanced techniques.
Purpose of the Study:
- To compare the outcomes of CTO revascularisation using antegrade versus retrograde approaches in a single center.
- To evaluate the safety and efficacy of the retrograde technique in a real-world setting.
Main Methods:
- A retrospective analysis of 159 CTO revascularisation procedures (January 2011-September 2013).
- 124 procedures used an antegrade approach, and 35 used a retrograde approach.
- Patient demographics, procedural details, and outcomes were compared between the two groups.
Main Results:
- Both approaches had similar patient characteristics and low complication rates.
- The antegrade approach had a higher procedural success rate (87.9%) compared to the retrograde approach (74.3%).
- The retrograde approach was associated with significantly longer fluoroscopy times and higher contrast volume.
Conclusions:
- High success rates for CTO revascularisation can be achieved with adequate experience and novel equipment.
- The retrograde technique is a safe and effective option for CTO revascularisation, particularly for complex cases.
- While resource-intensive, the retrograde approach expands treatment possibilities for CTO.
Background:
The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach.
Aim:
This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach.
Methods:
From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach.
Results:
All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001).
Conclusions:
Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.
