title: Retrograde Wiring of Collateral Channels of the Heart in Chronic Total Occlusions: A Systematic Review and Meta-Analysis of Safety, Feasibility, and Incremental Value in Achieving Revascularization.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis on retrograde wiring in chronic total occlusions (CTOs) with focus on its safety and feasibility.
  
  
  RESULTS
  We searched publications from 1990 to December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting a number of terms relating to the collateral circulation of the heart in CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO revascularization attempts fulfilled criteria for a study of retrograde wiring of collateral channels in CTOs. There were no randomized studies comparing a primary antegrade with a primary retrograde approach. Procedural CTO revascularization rates ranged from 67% to 90.6% with a large proportion having previously failed an "antegrade" approach. The septal perforator collaterals and epicardial channels were used in 73.2% (n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary perforation was not infrequent (n = 90, 5%), serious acute complications were uncommon; in the combined population 18 cases of cardiac tamponade (0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was significantly more likely to be successful compared to epicardial coronary artery wiring (72.5%) when chosen by the operator as a route of retrograde access to the CTO body (relative risk 1.11 [95% confidence interval: 1.02-1.20; P = .013]).
  
  
  CONCLUSIONS
  Successful retrograde wiring of collateral channels in selected patients undertaken by "CTO dedicated" operators can significantly enhance the chances of revascularization of complex CTOs with a low risk of acute serious complications. Septal perforator channels are significantly more likely to be successfully retrogradely wired compared to epicardial vessels when either is selected, by reference to their anatomical suitability by the operator, as a route of access.
authors.affiliation: Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom School of Ageing and Chronic Diseases, University of Liverpool, Liverpool, United Kingdom akhand31@aol.com.
authors.forename: Aleem
authors.initials: A
authors.lastname: Khand
authors.affiliation: Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Bilal
authors.initials: B
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Palmer
authors.affiliation: Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Andron
authors.affiliation: Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Raph
authors.initials: R
authors.lastname: Perry
authors.affiliation: Department of Cardiology, Narayana Hrudayalaya, Bangalore, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mehrotra
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D002908:Chronic Disease; D002983:Clinical Competence; D003097:Collateral Circulation; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends; D012307:Risk Factors; D016896:Treatment Outcome
keywords: chronic total occlusions; collateral circulation; retrograde wiring