Retrograde-Guided Antegrade Puncture Reentry Technique for Retrograde CTO PCI: Procedural Outcome and Safety
Zehan Huang1, QiHeng Wan1, YaoJun Zhang2
1Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Background:
Improving the efficiency of traversing the occluded segment is important in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We developed the retrograde-guided antegrade puncture reentry (RPR) technique to improve procedural efficiency while maintaining safety in retrograde CTO PCI.
Methods:
This retrospective study included 336 patients who underwent retrograde CTO PCI between July 2024 and August 2025. Patients were categorized into the RPR group, the Non-RPR group, and the Directly Crossing group. The primary outcome was CTO crossing time, defined as the interval from retrograde guidewire crossing of the collateral channel to wire externalization or wiring crossing into distal true lumen. Subgroup analyses were performed within the RPR cohort, and multivariate logistic regression was used to identify predictors of RPR success.
Results:
Despite higher lesion complexity in the RPR group, CTO crossing time was significantly shorter with RPR than with Non-RPR strategies (13 [6-24.75] min vs. 25 [15-43] min; p < 0.001). Primary RPR achieved successful reentry in 67% of cases and demonstrated the shortest crossing time among all strategies. Failed RPR did not prolong subsequent bailout R-CART. Complications were infrequent, including a 2.3% perforation rate, and no in-hospital mortality in the RPR group. Calcification and occlusion length were independent predictors of RPR failure, whereas prior CTO PCI was associated with higher likelihood of RPR success.
Conclusions:
RPR is a safe and efficient adjunct to retrograde CTO PCI and may serve as an effective initial reentry strategy in selected cases.
