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Active Retrograde Extra Backup with a Mother-and-Child Catheter to Facilitate Retrograde Microcatheter Collateral
Yong Wang1, Xiao-Jiao Zhang1, Hong-Wei Zhao1
1Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, China.
Insights
Active retrograde backup (ARB) is a safe and feasible technique for chronic total occlusion (CTO) treatment during retrograde percutaneous coronary intervention (PCI). This method enhances procedural efficiency and guidewire tracking, making it a valuable approach for CTO recanalization.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Medical Devices
Background:
- Retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) relies on effective guidewire and microcatheter tracking.
- The role of active retrograde backup (ARB) using a mother-and-child catheter in this process requires further investigation regarding its feasibility and safety.
Purpose of the Study:
- To evaluate the feasibility and safety of employing active retrograde backup (ARB) during retrograde percutaneous coronary intervention (PCI) for treating coronary chronic total occlusions (CTOs).
Main Methods:
- Retrospective analysis of 271 consecutive patients with CTO undergoing retrograde PCI between January 2015 and January 2020.
- Comparison of clinical data between patients treated with ARB and those without ARB to assess feasibility and safety outcomes.
Main Results:
- Active retrograde backup (ARB) was utilized in 47.6% of cases, primarily through septal or epicardial collateral channels.
- The ARB group showed significantly shorter retrograde microcatheter tracking times, retrograde approach duration, radiation dose, fluoroscopy time, and contrast volume compared to the non-ARB group.
- No life-threatening procedural complications were observed in either group, with similar rates of major adverse cardiac and cerebrovascular events.
Conclusions:
- Active retrograde backup (ARB) is a feasible and safe technique for facilitating guidewire and microcatheter tracking in coronary CTO recanalization.
- ARB improves procedural efficiency and is recommended for wider adoption in clinical practice.
Objective:
To explore the feasibility and safety of the active retrograde backup (ARB) for treatment of chronic total occlusion (CTO) during retrograde percutaneous coronary intervention (PCI).
Background:
Guiding support plays an important role in guidewire and microcatheter coronary channel (CC) tracking in retrograde PCI therapy for patients with CTO. However, the feasibility and safety of retrograde active use of a mother-and-child catheter are still unclear. Patients and Methods. A total of 271 consecutive patients with CTO who underwent retrograde PCI between January 2015 and January 2020 were retrospectively analyzed. Clinical data of two groups were compared to evaluate the feasibility and safety of ARB.
Results:
Of the 271 patients, 69.0% (187/271) underwent therapy through the septal branch, 31.0% (84/271) through the epicardial collateral channel, and 47.6% (129/271) through active retrograde extra backup with a mother-and-child catheter to facilitate retrograde microcatheter collateral CC tracking. The time of wire CC tracking was shorter in the ARB group than that in the non-ARB group (25.4 ± 8.5 vs 26.4 ± 9.7, p=0.348), but there was no significant difference. The duration of the retrograde microcatheter tracking (10.2 ± 3.8 vs 15.5 ± 6.8, p=0.012) and the retrograde approach (62.8 ± 20.3 vs 70.4 ± 24.3, p=0.026) in the ARB group was significantly shorter than that in the non-ARB group. The radiation dose (223.6 ± 112.7 vs. 295.2 ± 129.3, p=0.028), fluoroscopy time (50.6 ± 21.3 vs 62.3 ± 32.1, p=0.030), and contrast volume (301.8 ± 146.7 vs 352.2 ± 179.5, p=0.032) in the ARB group were significantly lower than that in the non-ARB group. There were no life-threatening procedural complications in either group. Complications unrelated to ARB included two cases of donor-vessel dissection, one case of CC perforation, and two cases of target-vessel perforation. There was no statistically significant difference in major adverse cardiac and cerebrovascular events between the groups during hospitalization (p > 0.05).
Conclusion:
ARB is feasible, safe, and conducive to guidewire and microcatheter CC tracking in the recanalization of coronary CTO. It improves procedural efficiency and is worthy of further promotion.
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