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Retrograde Versus Antegrade Approach for Coronary Chronic Total Occlusion in an Algorithm-Driven Contemporary
Eugene B Wu1, Etsuo Tsuchikane2, Lei Ge3
1Prince of Wales Hospital, Hong Kong, China.
Insights
Experienced operators using a retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) achieve high success rates. Algorithm-driven CTO PCI improves efficiency and reduces complications.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Algorithm-driven chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly utilized, with registries demonstrating favorable outcomes.
- This study introduces a novel algorithm for CTO PCI and evaluates its application within a contemporary multicenter registry.
- A comparative analysis of retrograde versus antegrade approaches in CTO PCI was performed.
Purpose of the Study:
- To establish and apply a new algorithm for CTO PCI.
- To compare the outcomes of retrograde and antegrade approaches in CTO PCI.
- To document the results of CTO PCI using a contemporary multicenter registry.
Main Methods:
- A registry was compiled including consecutive patients undergoing CTO PCI between January 1, 2016, and December 31, 2016.
- Eight high-volume CTO operators performed the CTO PCI procedures.
- Data on technical and procedural success rates, approach (antegrade vs. retrograde), and major adverse cardiac events (MACE) were collected.
Main Results:
- Overall technical and procedural success rates were 93.8% and 89.9%, respectively, for 497 CTOs in 485 patients.
- Antegrade approach showed higher technical (95.9% vs. 91.2%, p=0.03) and procedural success (94.4% vs. 84.6%, p<0.001) compared to retrograde.
- Pure retrograde success was 80% and pure antegrade success was 75%. In-hospital MACE was 3.8%, with a higher incidence in the retrograde group (6.6% vs. 1.5%).
Conclusions:
- The retrograde approach, when performed by well-trained, experienced operators, yields high success rates in complex CTO lesions.
- Algorithm-based CTO PCI enhances procedural efficiency, reduces contrast and radiation exposure, and minimizes failure time.
- These advancements are crucial for the future development of CTO PCI techniques.
Background:
The use of a retrograde approach and algorithm-driven CTO (chronic total occlusion) percutaneous coronary intervention (PCI) has become widespread, and many registries have reported good results. This study established a new algorithm and applied it to current CTO practice and collected a CTO registry to document the results. It compared the outcomes of a retrograde versus antegrade approach in a contemporary multicentre CTO registry.
Methods:
Between 1 January 2016 and 31 December 2016, consecutive patients who underwent CTO PCI performed by eight high-volume CTO operators were included in a registry.
Results:
During this period, 485 patients with 497 CTOs were treated with technical and procedural success rates of 93.8% and 89.9%, respectively. Antegrade and retrograde technical success was 95.9% and 91.2% (p = 0.03), respectively. Procedural success for antegrade and retrograde was 94.4% and 84.6%, respectively (p < 0.001). The pure retrograde success rate was 80% and pure antegrade success rate was 75%. Technical success in different Japanese Chronic Total Occlusion (JCTO) score groups was 100% (JCTO 0), 96.2% (JCTO 1), 95.3% (JCTO 2), and 92.5% (JCTO ≥ 3), with no statistical difference in success rates between different JCTO scores. In-hospital major adverse cardiac event (MACE) was 3.8% and more common in the retrograde group (6.6% vs 1.5%).
Conclusions:
The retrograde approach, when used by experienced operators who have been well trained in retrograde approach, can produce higher retrograde success in complex CTO lesions. The use of an algorithm approach can improve procedural efficiency, reduce contrast and radiation dosage, and reduce the time spent in failure mode. These tools remain vital to the development of future CTO PCI.
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