Related Experiment Video
Updated: May 11, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An
Ahmed Abdelaziz1, Abdelrahman Hafez1, Karim Atta2
1Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Insights
The retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is linked to increased risks of adverse events compared to the antegrade technique. This suggests the antegrade approach may be preferable for most CTO PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Technology
Background:
- The retrograde approach has improved success rates for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- However, retrograde techniques may increase procedural time, fluoroscopy, and contrast dye usage.
- This study compares in-hospital and long-term outcomes of retrograde versus antegrade approaches in CTO PCI.
Purpose of the Study:
- To compare the in-hospital and long-term outcomes of retrograde versus antegrade approaches in CTO PCI.
- To evaluate the safety and efficacy of different CTO PCI strategies.
Main Methods:
- A systematic review and meta-analysis of studies comparing retrograde and antegrade approaches in CTO PCI.
- Searched PubMed, Scopus, WOS, and Cochrane Central databases until June 2023.
- Synthesized outcome data using a random-effects model, reporting effect estimates as odds ratios (OR) or mean difference (MD) with 95% confidence intervals (CI).
Main Results:
- 18 studies with 21,276 patients were included.
- The antegrade approach was associated with significantly lower odds of major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), urgent pericardiocentesis, contrast-induced nephropathy (CIN), procedural complications, and target vessel perforation.
- The antegrade approach also demonstrated higher success rates.
Conclusions:
- The retrograde approach is associated with a higher risk of in-hospital and long-term adverse events compared to the antegrade technique.
- The antegrade approach is generally preferred for CTO PCI due to better safety outcomes.
- Retrograde techniques may be reserved for more complex CTO lesions where antegrade approaches are not feasible.
Background:
Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI.
Methods:
We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI).
Results:
A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22).
Conclusion:
Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.
More Related Videos
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Angina IV: Management
01:27Peripheral Artery Disease III: Interprofessional Care