Current Retrograde Approach Is Unfavorable to Long-Term Clinical Outcomes after Percutaneous Coronary Intervention
Zhuhua Zhang1, Dawei Zhang1, Osamu Katoh2
1Art Museum HouJie, Beijing Hospital of Traditional Chinese Medicine, affiliated with Capital Medical University, Beijing, Dongcheng District, Beijing, 100010, China.
Insights
The retrograde approach for coronary chronic total occlusion (CTO) intervention showed higher restenosis and major adverse cardiac events within one year compared to the antegrade approach. Long-term outcomes favor the antegrade method for CTO recanalization.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Coronary chronic total occlusion (CTO) interventions utilize antegrade and retrograde wire-based approaches.
- The retrograde approach demonstrates higher procedural success rates, but long-term efficacy remains uncertain.
Purpose of the Study:
- To compare the long-term clinical outcomes of antegrade versus retrograde approaches for percutaneous coronary intervention (PCI) in CTO patients.
- To evaluate restenosis and major adverse cardiac events (MACE) rates between the two approaches.
Main Methods:
- A total of 187 patients with CTOs were enrolled.
- Patients underwent PCI using either antegrade (single wire, parallel wire, side branch techniques) or retrograde (kissing wire, CART, reverse CART techniques) approaches.
- Baseline characteristics and procedural outcomes were assessed.
Main Results:
- Antegrade and retrograde groups exhibited similar baseline characteristics with minor variations.
- Within one year post-procedure, the retrograde group showed significantly higher rates of restenosis and MACE compared to the antegrade group.
Conclusions:
- The retrograde approach for CTO recanalization may be associated with less favorable long-term clinical outcomes compared to the antegrade approach.
- Further research is warranted to fully elucidate the long-term benefits and risks of each CTO intervention strategy.
Abstract:
Surgeons currently use two different wire-based approaches to recanalize coronary chronic total occlusion (CTO): antegrade and retrograde. It has been demonstrated that the retrograde approach has improved the procedural success rate, but it remains unclear whether the retrograde approach is better than the antegrade approach for the long term. In this study, we enrolled a total of 187 patients with a diagnosis of CTOs. We evaluated the baseline characteristics of these patients and performed percutaneous coronary intervention to treat their problems by using either antegrade or retrograde approaches and different techniques in both groups. In the antegrade approach, we used three techniques: single wire, parallel wire, and side branch. The techniques in retrograde included kissing wire, controlled antegrade and retrograde subintimal tracking (CART), and reverse CART. We found that the antegrade and retrograde groups had similar baseline characteristics, with a few minor differences. Most importantly, we found that within 1 yr of the recanalizing procedure, the restenosis rate and major adverse cardiac event rate of the retrograde group were significantly higher compared to the antegrade group. We conclude that the retrograde approach may not be as beneficial as the antegrade approach for long-term clinical outcomes.
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