Initial experience of retrograde wire approach in coronary chronic total occlusion intervention.
OBJECTIVE
Retrograde wire approach has been emerged as a useful tool to enhance success rate in coronary chronic total occlusion (CTO) intervention. Therefore, we tried to report the initial experience of retrograde approach and its clinical implication on CTO intervention.


METHODS
From February 2007 to July 2008, retrograde approaches were performed in 28 patients with 31 CTO lesions out of 61patients. A hydrophilic coated guidewire was inserted by using microcatheter or over-the-wire (OTW) balloon through the collateral channel (septal or epicardial artery) via several strategies.


RESULTS
Mean age of patients was 63.4+/-11.6 years. Male and female were 20 and 8 patients, respectively. The target artery with CTO lesions included the right coronary artery (45.2%), the left anterior descending artery (51.6%), and the left circumflex artery (3.2%). The mean length of CTO lesion was 18.4+/-16.4 mm. Overall technical success rate was 64.5%. The success rate of primary attempt was 78.9%, while the success rate of immediate and secondary attempt was 41.7%. Collateral channel dissections were observed in 3 patients and no patients among these patients developed cardiac tamponade. One patient had a silent non-Q wave myocardial infarction (MI) after the procedure. One failed patient died suddenly 3 days after the procedure. After percutaneous coronary intervention (PCI) procedure, no case was performed target vessel revascularization (TVR), urgent coronary artery bypass graft (CABG), and urgent PCI.


CONCLUSIONS
Retrograde approach is an evolving technique to improve the success rate of CTO intervention. After the learning curve period, this technique could be the useful tool to enhance success rate in CTO intervention.
Chung
Suk Hwan
SH
Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
Kim
Moo Hyun
MH
Yu
Long Hao
LH
Park
Jong Sung
JS
Kim
Kyung Ho
KH
Kum
Dong Sung
DS
Park
Tae Ho
TH
Cha
Kwang Soo
KS
Kim
Young Dae
YD