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Technical and procedural outcomes of the retrograde approach to chronic total occlusion interventions
Peter Tajti1, Iosif Xenogiannis, Fotis Gargoulas
1Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Insights
The retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is used for complex cases but has lower success rates and higher complication risks compared to antegrade-only PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The retrograde approach is essential for successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- However, this technique is linked to increased complication risks.
- Contemporary outcomes require examination to identify areas for improvement.
Purpose of the Study:
- To evaluate the outcomes of the retrograde approach in contemporary CTO PCI.
- To compare retrograde versus antegrade-only CTO PCI outcomes.
- To identify areas needing improvement in retrograde CTO PCI.
Main Methods:
- A multicentre registry (PROGRESS-CTO) compared retrograde (n=1,515) and antegrade-only (n=2,686) CTO PCIs.
- Patient demographics, lesion complexity (J-CTO score), collateral channel use, and procedural outcomes were analyzed.
- In-hospital major complications, including mortality and acute myocardial infarction, were compared.
Main Results:
- Retrograde PCI patients were older, predominantly male, and had higher rates of prior cardiovascular events and interventions.
- The mean J-CTO score was significantly higher for retrograde PCI (3±1 vs 2±1).
- Technical success (79% vs 91%) and procedural success (75% vs 90%) were lower with the retrograde approach. Major complications were higher in the retrograde group (5.1% vs 0.8%), including mortality (1.1% vs 0.1%) and acute myocardial infarction (1.9% vs 0.2%).
Conclusions:
- The retrograde approach for CTO PCI is utilized in more complex lesions.
- This approach is associated with lower technical and procedural success rates.
- Higher rates of major complications, including mortality and myocardial infarction, are observed with the retrograde technique.
Aims:
The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement.
Methods And Results:
We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001).
Conclusions:
In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications.
Clinical Trial Registration:
NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
