title: Comparison of the ipsi-lateral versus contra-lateral retrograde approach of percutaneous coronary interventions in chronic total occlusions.
abstract: BACKGROUND
  Retrograde recanalization of coronary chronic total occlusions (CTO) via contralateral (CL) collateral connections (CCs) is successful in 60-70% of patients in whom conventional antegrade approach fails or is unpromising. This study describes our experience with retrograde CTO-PCI via ipsi-lateral (IL) CCs in patients with unfavorable CL CCs.
  
  
  METHODS
  Between January 2013 and September 2015, 392 consecutive CTO procedures were performed by two high volume CTO-operators and the relevant data were fed into an online registry (ERCTO® EuroCTO-club). Most patients (222/392; 57%) were approached antegradely, whereas 43% were attempted retrogradely (170/392). After exclusion of all procedures performed via bypass-grafts (n = 12), PCI via CL CCs, the CL-group (n = 114/158; 72%), was compared with the IL-group that was attempted via IL CCs (n = 44/158; 28%).
  
  
  RESULTS
  Both groups were similar with respect to risk factors and morphologic criteria of CTO-severity. The initial primary strategy was successful in 78% in the CL-group and in 68% in the IL-group. In both patient groups, the initial strategy had to be switched in five patients from CL toward IL (4.4%, n = 5/114) and from IL to CL (11.3% n = 5/44). The rate of major complications was 7% (CL) and 5% (IL), respectively (n.s.). After retrograde failure and cross-over to an antegrade controlled re-entry strategy the overall success rates increased to 92% (CL) and 93% (IL).
  
  
  CONCLUSIONS
  In experienced hands retrograde CTO-PCI via IL CCs appears as safe and successful as the CL approach. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany.|Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Kambis
authors.initials: K
authors.lastname: Mashayekhi
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.affiliation: Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany.|Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Zivile
authors.initials: Z
authors.lastname: Valuckiene
authors.affiliation: Department of Cardiology, Interventional Electrocardiology and Hypertension; Institute of Cardiology, Jagiellonian University Medical College, Krakau, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.affiliation: Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Neuser
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: Main Taunus Heart Institute, Bad Soden, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Reifart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: CTO; chronic total occlusion; collaterals; contra-lateral; ipsi-lateral; retrograde