Complications during retrograde approach for chronic coronary total occlusion: Sub-analysis of Japanese multicenter
Atsunori Okamura1, Masahisa Yamane2, Makoto Muto3
1Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
Insights
Retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has low major adverse cardiac and cerebrovascular events (MACCE). Complications from the retrograde approach are acceptable, with septal channels being safer than epicardial ones.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) improves treatment success.
- However, complications like collateral channel and donor artery injury are associated with the retrograde approach.
Purpose of the Study:
- To determine complications during retrograde PCI for CTO.
- Analysis based on the prospective, nonrandomized Retrograde Summit registry.
Main Methods:
- Data from 1,166 patients undergoing retrograde PCI for CTO across 28 Japanese centers (2009-2011).
- Analysis of in-hospital MACCE and retrograde approach-specific complications.
Main Results:
- Overall and retrograde procedure success rates were 84.5% and 71.9%, respectively.
- In-hospital MACCE occurred in 1.5% of patients.
- Retrograde approach complications included channel injury (9.5%, requiring treatment in 2.1%) and donor artery problems (0.9%). Septal channels were safer than epicardial channels.
Conclusions:
- Retrograde PCI for CTO demonstrated a low MACCE rate.
- The frequency of complications related to the retrograde approach was deemed acceptable.
Objectives:
This study was performed to determine the complications occurring during retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) based on analysis of the multicenter, prospective, nonrandomized Retrograde Summit registry.
Background:
Retrograde PCI for CTO has improved treatment success rates, but several complications related to the retrograde approach have been reported, including collateral channel injury and donor artery injury due to their use as retrograde roots.
Methods:
This registry included data from 1,166 patients who underwent retrograde PCI for CTO in 28 Japanese centers between January 2009 and December 2011.
Results:
Overall procedure success and retrograde procedure success were achieved in 985 (84.5%) and 838 (71.9%) of the 1,166 patients, respectively. In-hospital major adverse cardiac and cerebrovascular events (MACCE) occurred in 18 (1.5%) of the 1,166 patients. With regard to complications related to the retrograde approach, channel injury occurred in 111 (9.5%) of the 1,166 patients, but treatment was required in only 24 (2.1%) patients and subsequent cardiac tamponade occurred in only 4 (0.3%) patients. Donor artery problems occurred in only 10 (0.9%) of the 1,166 patients. In sub-analysis regarding the types of collateral channels, the septal channel was significantly safer than epicardial channel because of the lower frequency of non-Q-wave myocardial infarction (non-QMI) and channel injury requiring treatment.
Conclusions:
The MACCE rate during retrograde PCI for CTO determined from the Retrograde Summit registry was low and the frequency of complications related to the retrograde approach was acceptable. © 2015 Wiley Periodicals, Inc.
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