Recanalization strategy of retrograde angioplasty in patients with coronary chronic total occlusion -analysis of 24 cases, focusing on technical aspects and complications.
BACKGROUND
Retrograde approach through collateral channels was recently proposed to increase the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), but this approach is still an incompletely described technique.


METHODS
We analyzed 24 cases of retrograde PCI for CTO, which were done from July 2006 to April 2008.


RESULTS
Septal collaterals were more frequently used than epicardial collaterals (75% vs. 25%), without showing statistical differences in wire passage rate according to the size or location of the collaterals. Once the retrograde wire successfully crossed collateral (18/24 cases), CTO lesion was successfully crossed in all cases by using 4 different kinds of techniques: retrograde wire crossing (44%), kissing wire (22%), controlled antegrade and retrograde subintimal tracking (22%), and reverse controlled antegrade and retrograde subintimal tracking (11%). Among them, successful recanalization was achieved in 17 cases, yielding 71% retrograde PCI success rate. In failed cases with retrograde approach, 4 cases were recanalized by switching to antegrade approach. Thus, total PCI success rate was 88% (21/24 cases). There were several cases of unexpected complications mainly related to collateral-donor artery without in-hospital major adverse cardiac events (MACE). During clinical follow-up (median 10.3 months), overall MACE rate was 18% in the successful retrograde PCI group.


CONCLUSIONS
The retrograde approach can improve the success rate with PCI for CTO. However, strict case selection with systemized approach is essential due to the technical complexities accompanied by the potential risk of unexpected complications.
Lee
Nae-Hee
NH
Department of Medicine, University of SoonChunHyang College of Medicine, Bucheon, Republic of Korea. naeheelee@paran.com
Seo
Hye-Sun
HS
Choi
Jae-Hyuk
JH
Suh
Jon
J
Cho
Yoon Haeng
YH
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies