Author + information
- Received April 23, 2012
- Revision received June 19, 2012
- Accepted June 27, 2012
- Published online December 1, 2012.
- Dimitri Karmpaliotis, MD⁎,
- Tesfaldet T. Michael, MD, MPH†,‡,
- Emmanouil S. Brilakis, MD, PhD†,‡,⁎ (, )
- Aristotelis C. Papayannis, MD†,‡,
- Daniel L. Tran, MSc†,‡,
- Ben L. Kirkland, BS⁎,
- Nicholas Lembo, MD⁎,
- Anna Kalynych, MD⁎,
- Harold Carlson, MD⁎,
- Subhash Banerjee, MD‡,†,
- William Lombardi, MD§ and
- David E. Kandzari, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Emmanouil S. Brilakis, Dallas Veterans Affairs Medical Center (111A), 4500 South Lancaster Road, Dallas, Texas 75216
Objectives This study sought to examine the contemporary outcomes of retrograde chronic total occlusion (CTO) interventions among 3 experienced U.S. centers.
Background The retrograde approach, pioneered and developed in Japan, has revolutionized the treatment of coronary CTO, yet limited information exists on procedural efficacy, safety, and reproducibility of outcomes in other settings.
Methods Between 2006 and 2011, 462 consecutive retrograde CTO interventions were performed at 3 U.S. institutions. Patient characteristics, procedural outcomes, and in-hospital clinical events were ascertained.
Results Mean patient age was 65 ± 9.7 years, 84% were men, and 50% had prior coronary artery bypass surgery. The CTO target vessel was the right coronary artery (66%), circumflex (18%), left anterior descending artery (15.5%), and left main artery or bypass graft (0.5%). The retrograde approach was used as the primary method in 46% of cases and after failed antegrade recanalization in 54%. Retrograde collateral vessels were septal (68%), epicardial (24%), and bypass grafts (8%). Technical and procedural success was 81.4% (n = 376) and 79.4% (n = 367), respectively. The mean contrast volume and fluoroscopy time were 345 ± 177 ml and 61 ± 40 min, respectively. A major complication occurred in 12 patients (2.6%). In multivariable analysis, years since initiation of retrograde CTO percutaneous coronary intervention (PCI) at each center, female sex, and ejection fraction ≥40% were associated with higher technical success.
Conclusions Among selected U.S. programs, retrograde CTO PCI is often performed in patients with prior coronary bypass graft surgery and is associated with favorably high success and low complication rates.
Dr. Karmpaliotis has served on the Speakers' Bureaus of Abbott Vascular and Medtronic and as a consultant to Bridgepoint Medical. Dr. Michael has received a Cardiovascular Training Grant from the National Institutes of Health, Award Number T32HL007360. Dr. Brilakis has received speaker honoraria from St. Jude Medical, Terumo, and Bridgepoint Medical and research support from Guerbet; his spouse is an employee of Medtronic. Dr. Lembo has served on the Speakers' Bureau of Medtronic and advisory boards of Abbott Vascular and Medtronic and as a proctor for BridgePoint Medical. Dr. Banerjee has received speaker honoraria from St. Jude Medical, Medtronic, Johnson & Johnson, Boehinger, Sanofi, and MDCare Global and research support from Boston Scientific and The Medicines Company. Dr. Lombardi has served as a consultant for Abbott Vascular, Bridgepoint Medical, and Medtronic; has received speaker honoraria from Abbott Vascular, Medtronic, and Terumo; and has equity in Bridgepoint Medical. Dr. Kandzari has received research/grant support from Abbott Vascular, Medtronic and Boston Scientific and an institutional educational grant from Bridgepoint Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Gregg Stone, MD, has served as Guest Editor for this paper.
- Received April 23, 2012.
- Revision received June 19, 2012.
- Accepted June 27, 2012.
- American College of Cardiology Foundation