title: Retrograde recanalization of chronic total occlusions from the transradial approach; early Canadian experience.
abstract: BACKGROUND
  Retrograde approach for chronic total occlusions (CTO) improves recanalization success rates. Eight French (Fr) catheters and the femoral approach are advocated.
  
  
  OBJECTIVE
  Evaluate whether transradial operators can achieve similar success rates using smaller catheters.
  
  
  METHODS
  This is a single-operator series of 42 consecutive cases performed between January and December 2010, including 13 while demonstrating CTO recanalization. Patients were referred because of complexity of the CTO or after failed attempt.
  
  
  RESULTS
  Most frequent indications for recanalization were CCS 3-4 angina (52%) and CCS 1-2 in 21%. Eighteen (43%) patients underwent previous failed attempts. CTO was in the right coronary in 74%, left anterior descending in 24%, and a left main in 1. Most lesions (88%) were ≥20 mm long and 52% were calcified. We used septal collateral channels (CC) in 33 (79%), epicardial CC in 8 (20%), and a saphenous vein graft in one case. Radial access was used in all patients and was bilateral in 37 (88%). Five cases required one radial and one femoral access. Six French guides were used in 91% for the retrograde side and 71% for the antegrade side. Otherwise, 7 Fr guides were used. The Corsair(®) was used in 38 (90%). Procedural success was achieved in 37 (88%), mostly using reverse controlled antegrade-retrograde tracking (60%) or retrograde crossing (29%). The average <24-h Hb drop was 0.75 ± 0.84 g/dl. No in-hospital major cardiac events occurred.
  
  
  CONCLUSIONS
  Transradial retrograde CTO recanalization is feasible, safe, and still associated with high success rates despite the use of smaller guide catheters.
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada. stephane.rinfret@criucpq.ulaval.ca
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.forename: Dominique
authors.initials: D
authors.lastname: Joyal
authors.forename: Can Manh
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: William
authors.initials: W
authors.lastname: Hui
authors.forename: Raymond
authors.initials: R
authors.lastname: Leung
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Michael P
authors.initials: MP
authors.lastname: Love
authors.forename: Samer
authors.initials: S
authors.lastname: Mansour
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec; D017534:Radial Artery / Q000000981:diagnostic imaging; D015641:Radiography, Interventional; D013997:Time Factors; D016896:Treatment Outcome