title: Recanalization of chronic total coronary occlusions--high success rate despite a restrictive use of the retrograde approach.
abstract: OBJECTIVE
  The retrograde approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly being used as a first-line intervention despite a higher radiation exposure, contrast volume, and a higher major adverse cardiac event (MACE) rate compared with the antegrade approach. It was aimed to evaluate the overall success rate of CTO-PCI over time when the retrograde approach was restrictively used only after a failed antegrade attempt.
  
  
  RESULTS
  In a prospective single operator registry from January 2008 to December 2012 about 436 consecutive patients underwent a CTO-PCI. Mean age was 63.4 ± 10.3 years, and 86% were male. The overall success rate improved significantly over time [68% (first quartile) to 91% (fourth quartile), P < 0.001] due to a significant increase of the antegrade success rate. This could be achieved by a retrograde approach of less than 20% with no change over time. The overall in-hospital MACE rate was 0.69% with no difference between antegrade and retrograde procedures.
  
  
  CONCLUSIONS
  A high CTO-PCI success rate of above 90% could be achieved with a restrictive use of the retrograde technique.
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany.
authors.forename: Klaudija
authors.initials: K
authors.lastname: Bijuklic
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schwencke
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
mesh_terms: D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
keywords: antegrade; chronic total occlusion; retrograde