title: Recanalisation of coronary chronic total occlusion by retrograde approach: the first experience in Poland.
abstract: BACKGROUND
  The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach.
  
  
  OBJECTIVE
  This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach.
  
  
  METHODS
  From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach.
  
  
  RESULTS
  All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001).
  
  
  CONCLUSIONS
  Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.
authors.affiliation: 1st Department of Cardiology, Interventional Electrocardiology, and Arterial Hypertension, Jagiellonian University, Medical College, University Hospital, Krakow, Poland. l_bryniarski@poczta.fm.
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.forename: Sławomir
authors.initials: S
authors.lastname: Surowiec
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Klima
authors.forename: Michał
authors.initials: M
authors.lastname: Terlecki
authors.forename: Piotr
authors.initials: P
authors.lastname: Jankowski
authors.forename: Marek
authors.initials: M
authors.lastname: Rajzer
authors.forename: Piotr
authors.initials: P
authors.lastname: Kusak
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Królikowski
authors.forename: Adam
authors.initials: A
authors.lastname: Curyło
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Żmudka
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Danuta
authors.initials: D
authors.lastname: Czarnecka
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D054059:Coronary Occlusion / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011044:Poland; D016896:Treatment Outcome