title: Changing strategies of the retrograde approach for chronic total occlusion during the past 7 years.
abstract: OBJECTIVE
  We reviewed the technical changes and results achieved with the retrograde approach since we introduced it 7 years ago.
  
  
  METHODS
  The subjects were 1,268 patients who were treated for CTO between January 2004 and December 2010. They were investigated with respect to the success rate, the frequency of employing the retrograde approach and its outcome, and other factors.
  
  
  RESULTS
  The retrograde approach was employed in ∼30% of chronic total occlusion (CTO) patients (n = 281) and the retrograde guidewire success rate was 81.1%. The kissing wire technique was substituted for the retrograde approach in 126 of the 281 patients, with antegrade crossing of a guidewire being successful in 88 of them (70%). The retrograde approach was combined with the CART and reverse controlled antegrade retrograde tracking (CART) techniques in 22 and 21 patients, respectively. Among 83 patients treated with Corsair catheters, crossing of the CTO was achieved in 63. The overall procedural success rate was 79.7% (224 patients). Complications of the retrograde approach included collateral channel dissection (2.1%), channel perforation (1.7%), CTO perforation (1.7%), and donor artery occlusion (1.1%).
  
  
  CONCLUSIONS
  The success rate and safety of the retrograde approach are both satisfactory if the appropriate devices and techniques are selected.
authors.affiliation: Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumu-ku, Yokohama-Shi, Kanagawa-Pref., Japan. t-mura@tj8.so-net.ne.jp
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Reiko
authors.initials: R
authors.lastname: Tsukahara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishimori
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Robert
authors.initials: R
authors.lastname: de Winter
authors.forename: Khaled
authors.initials: K
authors.lastname: Shokry
authors.forename: Lefeng
authors.initials: L
authors.lastname: Wang
authors.forename: Jiyan
authors.initials: J
authors.lastname: Chen
authors.forename: Haichang
authors.initials: H
authors.lastname: Wang
mesh_terms: D000368:Aged; D062906:Cardiac Catheters; D002908:Chronic Disease; D003097:Collateral Circulation; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000503:physiopathology / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome