title: Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: insights from a multicentre US registry.
abstract: OBJECTIVE
  The goal of this study was to describe the procedural characteristics, strategy selection and associated technical and efficiency outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the right coronary artery (RCA).
  
  
  RESULTS
  We examined the clinical and angiographic characteristics of patients who underwent RCA CTO PCI between 2012 and 2015 at 11 centres in the USA. The RCA was the CTO target vessel in 739 of 1,308 CTO PCIs (56%). Overall technical and procedural success rates were 90% and 88%, respectively. A major adverse cardiovascular event (MACE) occurred in 19 patients (2.6%). Technical success was most frequently achieved using antegrade wire escalation (38% of successful procedures) followed by retrograde (36%) and antegrade dissection/re-entry (26%). Technical success was similar between various locations of RCA CTOs (p=0.11). Compared with antegrade-only procedures, utilisation of any retrograde approach was associated with lower technical (85% vs. 95%, p<0.001) and procedural (82% vs. 94%, p<0.001) success and a higher MACE rate (3.8% vs. 1.4%, p=0.037).
  
  
  CONCLUSIONS
  RCA CTOs represent the majority of CTO target lesions, can be treated with high success and acceptable complication rates, and require frequent use of the retrograde approach and antegrade dissection/re-entry.
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.forename: Mitul P
authors.initials: MP
authors.lastname: Patel
authors.forename: John N
authors.initials: JN
authors.lastname: Bahadorani
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Lembo
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Doing
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Danek
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.forename: Aya
authors.initials: A
authors.lastname: Alame
authors.forename: Pratik
authors.initials: P
authors.lastname: Kalsaria
authors.forename: Craig
authors.initials: C
authors.lastname: Thompson
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000601:surgery*; D054059:Coronary Occlusion / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States