Sinisa Stojkovic 1 , George Sianos , Osamu Katoh , Alfredo R Galassi , Branko Beleslin , Vladan Vukcevic , Milan Nedeljkovic , Goran Stankovic , Dejan Orlic , Milan Dobric , Miloje Tomasevic , Miodrag Ostojic Show Affiliations »
Abstract
BACKGROUND: Retrograde approach increases the success rate for percutaneous recanalization of complex chronic total occlusion (CTO) of coronary arteries. OBJECTIVES: The purpose of this study was to describe our initial experience of retrograde percutaneous coronary intervention for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up. METHODS: The study was a single center retrospective registry which included a total of 40 patients, of 590 CTO treated patients (6.7%), between January 2008 and October 2011, who underwent retrograde approach for CTO recanalization. RESULTS: Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5% (35/40). Septal collaterals were used to access the occlusion in all cases (100%). Retrograde guidewire crossing of collateral channels was successful in 36/40 (90.0%) patients with success rate of CTO recanalization in these patients of 97.2%. Retrograde approach as the primary strategy was applied in 23/40 (57.5%) patients, retrograde approach immediately after antegrade failure attempt was performed in 8/40 (20.0%) patients, and retrograde approach as elective procedure, after previously failed antegrade attempt, was performed in 9/40 (22.5%) patients. The success rate of these strategies was: 87.0% (20/23 patients) for primary, 87.5% (7/8 patients) for retrograde immediately after antegrade failure, and 88.9% (8/9 patients) for retrograde after previous failed antegrade attempt, respectively. Total in-hospital major adverse cardiac events (MACE) rate was 5.0% (2 non-Q-wave myocardial infarctions). The MACE free survival at median follow-up of 20 months was 89% (95% CI: 78-100%). CONCLUSIONS: This study has demonstrated that adequate training and international proctorship for this complex and demanding technique is a necessity and prerequisite to achieve high overall success rates, with acceptable complication rates and excellent long-term survival rate. ©2012, Wiley Periodicals, Inc.
BACKGROUND: Retrograde approach increases the success rate for percutaneous recanalization of complex chronic total occlusion (CTO ) of coronary arteries. OBJECTIVES: The purpose of this study was to describe our initial experience of retrograde percutaneous coronary intervention for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up. METHODS: The study was a single center retrospective registry which included a total of 40 patients , of 590 CTO treated patients (6.7%), between January 2008 and October 2011, who underwent retrograde approach for CTO recanalization. RESULTS: Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5% (35/40). Septal collaterals were used to access the occlusion in all cases (100%). Retrograde guidewire crossing of collateral channels was successful in 36/40 (90.0%) patients with success rate of CTO recanalization in these patients of 97.2%. Retrograde approach as the primary strategy was applied in 23/40 (57.5%) patients , retrograde approach immediately after antegrade failure attempt was performed in 8/40 (20.0%) patients , and retrograde approach as elective procedure, after previously failed antegrade attempt, was performed in 9/40 (22.5%) patients . The success rate of these strategies was: 87.0% (20/23 patients ) for primary, 87.5% (7/8 patients ) for retrograde immediately after antegrade failure, and 88.9% (8/9 patients ) for retrograde after previous failed antegrade attempt, respectively. Total in-hospital major adverse cardiac events (MACE) rate was 5.0% (2 non-Q-wave myocardial infarctions ). The MACE free survival at median follow-up of 20 months was 89% (95% CI: 78-100%). CONCLUSIONS: This study has demonstrated that adequate training and international proctorship for this complex and demanding technique is a necessity and prerequisite to achieve high overall success rates, with acceptable complication rates and excellent long-term survival rate. ©2012, Wiley Periodicals, Inc.
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Year: 2012
PMID： 22897353 DOI： 10.1111/j.1540-8183.2012.00754.x
Source DB: PubMed Journal: J Interv Cardiol ISSN： 0896-4327 Impact factor: 2.279