OBJECTIVES: We sought to evaluate the results of the antegrade versus retrograde chronic total occlusion (CTO) technique with intravascular ultrasound (IVUS) imaging. BACKGROUND: The most common failure mode of CTO interventions remains the inability to successfully cross the occlusion with a guidewire. Recently, the retrograde approach through collateral channels has been introduced to cross complex CTOs. METHODS: Between October 2002 and April 2008, IVUS was performed in 48 de novo CTO lesions after guidewire crossing +/- pre-dilation with a 1.5- to 2.0-mm balloon. Twenty-three lesions were treated via the antegrade approach (Ante), and 25 lesions were treated via the retrograde approach (Retro). RESULTS: Right coronary artery (RCA) CTOs were treated more frequently via the Retro technique. Although the CTO length was much longer in the Retro group (45 +/- 26 mm vs. 18 +/- 9 mm, p < 0.0001), at the end of the procedure Thrombolysis In Myocardial Infarction flow grade 3 was obtained in all patients. There were no significant differences between the 2 groups in minimum stent area and stent expansion. However, the incidence of the composite end point-subintimal wiring, angiographic extravasation, coronary hematoma, or IVUS-detected coronary perforation-was higher in the Retro group (68% vs. 30%, p = 0.01); and the guidewire was more often subintimal in the Retro group (40% vs. 9%, p = 0.02). CONCLUSIONS: The retrograde approach is a promising option for complex CTO segments, especially long RCA CTOs. Intravascular ultrasound can be a useful tool for the detection of procedure-related vessel damage and subintimal wire tracking.
OBJECTIVES: We sought to evaluate the results of the antegrade versus retrograde chronic total occlusion (CTO) technique with intravascular ultrasound (IVUS) imaging. BACKGROUND: The most common failure mode of CTO interventions remains the inability to successfully cross the occlusion with a guidewire. Recently, the retrograde approach through collateral channels has been introduced to cross complex CTOs. METHODS: Between October 2002 and April 2008, IVUS was performed in 48 de novo CTO lesions after guidewire crossing +/- pre-dilation with a 1.5- to 2.0-mm balloon. Twenty-three lesions were treated via the antegrade approach (Ante), and 25 lesions were treated via the retrograde approach (Retro). RESULTS: Right coronary artery (RCA) CTOs were treated more frequently via the Retro technique. Although the CTO length was much longer in the Retro group (45 +/- 26 mm vs. 18 +/- 9 mm, p < 0.0001), at the end of the procedure Thrombolysis In Myocardial Infarction flow grade 3 was obtained in all patients. There were no significant differences between the 2 groups in minimum stent area and stent expansion. However, the incidence of the composite end point-subintimal wiring, angiographic extravasation, coronary hematoma, or IVUS-detected coronary perforation-was higher in the Retro group (68% vs. 30%, p = 0.01); and the guidewire was more often subintimal in the Retro group (40% vs. 9%, p = 0.02). CONCLUSIONS: The retrograde approach is a promising option for complex CTO segments, especially long RCA CTOs. Intravascular ultrasound can be a useful tool for the detection of procedure-related vessel damage and subintimal wire tracking.
Authors: Lei Song; Akiko Maehara; Matthew T Finn; Sanjog Kalra; Jeffrey W Moses; Manish A Parikh; Ajay J Kirtane; Michael B Collins; Tamim M Nazif; Khady N Fall; Raja Hatem; Ming Liao; Tiffany Kim; Philip Green; Ziad A Ali; Candido Batres; Martin B Leon; Gary S Mintz; Dimitri Karmpaliotis Journal: JACC Cardiovasc Interv Date: 2017-05-22 Impact factor: 11.195
Authors: Krzysztof L Bryniarski; Michał Zabojszcz; Grzegorz Dębski; Jakub Marchewka; Jacek Legutko; Sławomir Surowiec; Zbigniew Siudak; Krzysztof Żmudka; Dariusz Dudek; Leszek Bryniarski Journal: Postepy Kardiol Interwencyjnej Date: 2015-06-22 Impact factor: 1.426
Authors: Judit Karacsonyi; Khaldoon Alaswad; Farouc A Jaffer; Robert W Yeh; Mitul Patel; John Bahadorani; Aris Karatasakis; Barbara A Danek; Anthony Doing; J Aaron Grantham; Dimitri Karmpaliotis; Jeffrey W Moses; Ajay Kirtane; Manish Parikh; Ziad Ali; William L Lombardi; David E Kandzari; Nicholas Lembo; Santiago Garcia; Michael R Wyman; Aya Alame; Phuong-Khanh J Nguyen-Trong; Erica Resendes; Pratik Kalsaria; Bavana V Rangan; Imre Ungi; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis Journal: J Am Heart Assoc Date: 2016-08-20 Impact factor: 5.501