title: Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: procedural outcomes and predictors of success in contemporary practice.
abstract: BACKGROUND
  Retrograde approach through collaterals has been introduced for percutaneous recanalization of chronic total occlusion (CTO) of the coronary arteries. We investigated the safety and efficacy of retrograde approaches used for percutaneous recanalization of CTO in a consecutive series of patients.
  
  
  RESULTS
  We studied 157 consecutive patients who underwent retrograde CTO recanalization between 2003 and 2008 at a single center. A total of 118 (75.2%) of these patients have had previously failed antegrade attempts. Septal, epicardial, and saphenous vein graft collaterals were used in 67.5%, 24.8%, and 7.6% of cases, respectively. Collateral channel was crossed by guide wire successfully in 115 (73.2%) cases, and the procedure was successful by retrograde approach in 103 (65.6%) cases. Collateral channels (CCs) were graded as follows: CC0, no continuous connection; CC1, continuous thread-like connection; and CC2, continuous, small sidebranch-like connection. CC1, collateral tortuosity < 90 degrees , and angle with recipient vessel < 90 degrees (P<0.0001) were significant predictors of success. Epicardial channel use (P=0.01), CC0, corkscrew channel (P<0.0001), angle with recipient vessel > 90 degrees (P=0.0007), and nonvisibility of connection with recipient vessel were found to be significant predictors of procedural failure. The CC dissection was observed in 6 patients, with 1 needing coil embolization and others who were managed conservatively. The major adverse cardiac events were low, with 1 coronary artery bypass graft, 1 Q-wave myocardial infarction, 5 non-Q-wave myocardial infarctions, and no deaths in this group of patients.
  
  
  CONCLUSIONS
  The retrograde approach in CTO percutaneous coronary intervention is effective in recanalizing CTO. The success rate by retrograde approach was 65.6%, and final success was 85% in this group with acceptable overall adverse events. We have identified predictors of failure related to collateral morphology.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, Japan. sudhirrathore@hotmail.com
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rathore
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Keiko
authors.initials: K
authors.lastname: Asakura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asakura
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome