Kambis Mashayekhi1,2, Michael Behnes3, Zivile Valuckiene1,4, Leszek Bryniarski5, Ibrahim Akin3, Hans Neuser1, Franz-Josef Neumann2, Nicolaus Reifart6. 1. Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Plauen, Germany. 2. Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany. 3. First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. 4. Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 5. Department of Cardiology, Interventional Electrocardiology and Hypertension; Institute of Cardiology, Jagiellonian University Medical College, Krakau, Poland. 6. Main Taunus Heart Institute, Bad Soden, Germany.
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.
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.