title: Periprocedural ischaemia during recanalisation of chronic total coronary occlusions: the influence of the transcollateral retrograde approach.
abstract: OBJECTIVE
  Percutaneous coronary intervention for chronic total coronary occlusions (CTO) becomes increasingly more complex with the transcollateral retrograde approach. This study assesses the effect of the retrograde approach on markers of ischaemia and clinical events.
  
  
  RESULTS
  Four hundred and ninety-two consecutive procedures in 392 patients were prospectively evaluated. Before and within 18-24 hours after the PCI creatine kinase (CK) and cardiac troponin I (cTnI) were obtained. A CK increase of greater than three times the upper limit of normal (ULN) was considered a periprocedural MI. Patients with initially elevated cTnI were excluded. In 106 patients with a retrograde wire passage of the septal collaterals, the incidence of a CK or TnI increase was higher as compared to the antegrade group. Patients with septal dilatation or passage of a dilatation catheter (Corsair) showed the highest cTnI. There was no difference in cardiac death or cerebral complications between the groups with antegrade and retrograde approach within the first 30 days.
  
  
  CONCLUSIONS
  Complex retrograde recanalisation procedures for CTOs lead to an increased periprocedural ischaemic burden, most likely due to obstruction of the collateral pathway, and to the increased plaque burden of complex lesions treated with the retrograde approach.
authors.affiliation: Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.forename: Anja
authors.initials: A
authors.lastname: Coenen
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Tischer
mesh_terms: D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D003402:Creatine Kinase