Antegrade versus Retrograde Approach for Recanalization of Ostial or Stumpless Coronary Chronic Total Occlusion
Xi Wu1, Mingxing Wu1, Haobo Huang1
1Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People's Republic of China.
Insights
The antegrade-only approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) shows higher success rates and fewer complications than the retrograde approach. This method is preferred for less complex CTO lesions, reducing in-hospital major adverse cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) poses challenges in percutaneous coronary intervention (PCI).
- Ostial or stumpless CTO requires specialized techniques for successful revascularization.
- Evaluating different PCI approaches is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare procedural and in-hospital clinical outcomes of antegrade-only versus retrograde approaches for ostial or stumpless CTO PCI.
- To identify predictors of successful antegrade-only PCI in complex CTO cases.
Main Methods:
- Retrospective analysis of 89 consecutive patients undergoing ostial or stumpless CTO PCI.
- Comparison of technical and procedural success rates between antegrade-only and retrograde approaches.
- Assessment of in-hospital major adverse cardiac events (MACE) and myocardial infarction (MI).
Main Results:
- The antegrade-only approach had significantly higher technical (92.0% vs 71.9%) and procedural success rates (92.0% vs 68.8%) compared to the retrograde approach.
- The retrograde approach group had higher Japanese-CTO (J-CTO) scores and more frequent microchannels at the proximal stump.
- In-hospital MACE and MI were more prevalent in the retrograde approach group (18.8% and 15.6%, respectively).
- Low J-CTO score (<2) and proximal stump microchannels predicted successful antegrade-only PCI.
Conclusions:
- The antegrade-only approach is associated with better procedural outcomes and lower in-hospital MACE for ostial or stumpless CTO PCI.
- This approach is suitable for less complex CTO lesions.
- Predictors like J-CTO score and microchannel presence can guide treatment strategy.
Purpose:
This research aimed to evaluate the procedural and in-hospital clinical outcomes of percutaneous coronary intervention (PCI) for ostial or stumpless chronic total occlusion (CTO) utilizing both the antegrade-only and retrograde approaches.
Methods:
A comprehensive retrospective examination was conducted on the procedural and in-hospital clinical outcomes of 89 consecutive patients subjected to ostial or stumpless CTO PCI at our institution between April 2015 and October 2022.
Results:
The antegrade-only technique demonstrated a superior technical success rate (92.0% vs 71.9%, p = 0.041) and procedural success rate (92.0% vs 68.8%, p = 0.022) in comparison to the retrograde approach (RA). The RA group presented a notably elevated Japanese-CTO (J-CTO) score relative to the antegrade-only approach group (2.45±0.73 vs 1.64±0.70, p < 0.001). The antegrade-only approach group manifested an increased frequency of microchannels at the proximal stump relative to the RA group (56.0% vs 10.9%, p < 0.001). In-hospital major adverse cardiac events (MACE) and in-hospital myocardial infarction (MI) were observed more prevalently in the RA group (18.8% vs 0, p = 0.003; 15.6% vs 0, p = 0.008; respectively). A J-CTO score below 2 and the manifestation of microchannels at the proximal stump were identified as predictors for successful antegrade-only approach PCI for ostial or stumpless CTO (OR: 2.79 [95% CI: 1.92-5.03, P =0.003]; OR: 2.89 [95% CI: 1.32-6.03, P =0.001]; respectively).
Conclusion:
Relative to RA PCI for ostial or stumpless CTO, the antegrade-only approach is utilized for less complex CTO lesions and is associated with a diminished probability of in-hospital MACE.
