Retrograde approach for the recanalization of coronary chronic total occlusion: preliminary experience of a single center.
BACKGROUND
The success rate of antegrade approach for chronic total occlusions (CTO) recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. This report aimed to describe our experience of retrograde recanalization for CTO, focusing on its safety and feasibility.


METHODS
We identified 42 patients who underwent revascularization in CTO with retrograde approach from July 2005 to November 2009 in our center.


RESULTS
Three kinds of strategy were applied: retrograde as primary strategy (50.0%), retrograde immediately after antegrade failure (26.2%) and repeat procedure after previous antegrade failure (23.8%). Septal collaterals were more frequently used as the retrograde access route (92.9%). Overall success rate was 88.1%. In patients with successful retrograde wire crossing collateral channel to the distal cap of CTO, the success rate of recanalization was 94.1%. In patient with failure to cross the collaterals, the success rate was 62.5%. Eight different kinds of retrograde techniques were used: kissing wire technique (35.3%), wire trapped and reverse wire trapped technique (17.6%), back-end balloon and microcatheter reversal technique (14.7%), controlled antegrade and retrograde subintimal tracking (CART) technique (8.8%), reverse CART and modified reverse CART technique (8.8%), retrograde wire crossing technique (2.9%). There were 4 complications occurred without in-hospital major adverse cardiac events (MACE). In-hospital MACE was 7.7%. All of them were non-Q wave myocardial infarction. There were no cases of death or target vessel revascularization, either surgery or percutaneous.


CONCLUSIONS
The retrograde approach can be an effective tool for increasing the success rate of recanalization in the very complex CTO. To ensure the success and safety of the approach, careful case selection and device handling by experienced operators is essential.
Ge
Lei
L
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.
Qian
Ju-Ying
JY
Liu
Xue-Bo
XB
Qin
Qing
Q
Cui
Shan-Jing
SJ
Yao
Kang
K
Shen
Li
L
Ma
Jian-Ying
JY
Huang
Dong
D
Xu
Shi-Kun
SK
Zhang
Feng
F
Wang
Xiang-Fei
XF
Wang
Qi-Bing
QB
Fan
Bing
B
Yan
Yan
Y
Feng
Qi
Q
Wang
Hao
H
Shen
An
A
Zhu
Ming-Hui
MH
Ge
Jun-Bo
JB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D016896:Treatment Outcome