Author + information
- Received June 20, 2019
- Revision received September 16, 2019
- Accepted October 10, 2019
- Published online February 17, 2020.
- Iosif Xenogiannis, MDa,
- Fotis Gkargkoulas, MDb,
- Dimitri Karmpaliotis, MDb,
- Oleg Krestyaninov, MDc,
- Dmitrii Khelimskii, MDc,
- Farouc A. Jaffer, MD, PhDd,
- Jaikirshan J. Khatri, MDe,
- David E. Kandzari, MDf,
- R. Michael Wyman, MDg,
- Anthony H. Doing, MDh,
- Phil Dattilo, MDh,
- Catalin Toma, MDi,
- Robert W. Yeh, MDj,
- Hector Tamez, MDj,
- James W. Choi, MDk,
- Wissam Jaber, MDl,
- Habib Samady, MDl,
- Abdul M. Sheikh, MDm,
- Srinivasa Potluri, MDn,
- Mitul Patel, MDo,
- Ehtisham Mahmud, MDo,
- Basem Elbaruni, MDp,
- Michael P. Love, MDp,
- Michalis Koutouzis, MDq,
- Ioannis Tsiafoutis, MDq,
- Brian K. Jefferson, MDr,
- Taral Patel, MDr,
- Barry Uretsky, MDs,
- Jeffrey W. Moses, MDb,
- Nicholas J. Lembo, MDb,
- Manish Parikh, MDb,
- Ajay J. Kirtane, MDb,
- Ziad A. Ali, MDb,
- Allison B. Hall, MDa,
- Michael S. Megaly, MDa,
- Evangelia Vemmou, MDa,
- Ilias Nikolakopoulos, MDa,
- Bavana V. Rangan, BDS, MPHa,
- Pamela W. Morley, RNa,
- Bassel Bou Dargham, MDt,
- Shuaib Abdullah, MDt,
- Santiago Garcia, MDa,
- Subhash Banerjee, MDt,
- M. Nicholas Burke, MDa,
- Emmanouil S. Brilakis, MD, PhDa,∗ ( and )
- Khaldoon Alaswad, MDu
- aMinneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
- bColumbia University, New York, New York
- cMeshalkin Novosibirsk Research Institute, Novosibirsk, Russia
- dMassachusetts General Hospital, Boston, Massachusetts
- eCleveland Clinic, Cleveland, Ohio
- fPiedmont Heart Institute, Atlanta, Georgia
- gTorrance Memorial Medical Center, Torrance, California
- hMedical Center of the Rockies, Loveland, Colorado
- iUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- jBeth Israel Deaconess Medical Center, Boston, Massachusetts
- kBaylor Heart and Vascular Hospital, Dallas, Texas
- lEmory University Hospital Midtown, Atlanta, Georgia
- mWellstar Health System, Marietta, Georgia
- nThe Heart Hospital Baylor Plano, Plano, Texas
- oVA San Diego Healthcare System and University of California, San Diego, La Jolla, California
- pSt. Boniface General Hospital, Winnipeg, Manitoba, Canada
- qRed Cross Hospital of Athens, Athens, Greece
- rTristar Centennial Medical Center, Nashville, Tennessee
- sVA Central Arkansas Healthcare System, Little Rock, Arkansas
- tVA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
- uHenry Ford Hospital, Detroit, Michigan
- ↵∗Address for correspondence:
Dr. Emmanouil S. Brilakis, Minneapolis Heart Institute, 920 East 28th Street, #300, Minneapolis, Minnesota 55407.
Objectives The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Background The use of SVGs for retrograde crossing during CTO PCI has received limited study.
Methods A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group).
Results Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01).
Conclusions Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.
- chronic total occlusion
- percutaneous coronary interventions
- retrograde approach
- saphenous vein grafts
The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Jaffer is a consultant for Abbott Vascular, Boston Scientific, and Siemens; and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Khatri has received honoraria from Asahi Intecc; and is a speaker and proctor for Abbott Vascular. Dr. Kandzari has received research grants from Boston Scientific, Medtronic Cardiovascular, and Abbott; and is a consultant or advisory board member for Boston Scientific and Medtronic Cardiovascular. Dr. Wyman is a member of the Speakers Bureau for Boston Scientific, Abbott Vascular, and Asahi; has received honoraria from Boston Scientific, Abbott Vascular, and Asahi; and is a consultant or advisory board member for Boston Scientific, Abbott Vascular, and Asahi. Dr. Toma is a consultant for Abbott and Volcano Phillips. Dr. Yeh has received a career development award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. M. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; has received speaking fees from Medtronic, Corindus, and Abbott Vascular; has received educational program fees from Abbott Vascular; and has received clinical events committee fees from St. Jude. Dr. Jefferson has received honoraria and consulting and speaking fees from Abbott, Boston Scientific, Cardiovascular Systems, Inc., and Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic; and is a consultant or advisory board member for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureau for Abbott Vascular, Medtronic, Cardiovascular Systems, Inc., Boston Scientific, and Trireme; and is an advisory board member for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca; has ownership interest, partnership, and principal in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from Infraredx and The Spectranetics Corporation. Dr. Garcia has received consulting fees from Medtronic. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership interest in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, Amgen, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (board of directors), Cardiovascular Systems, Inc., Elsevier, Infraredx, GE Healthcare, Siemens, Teleflex, and Medtronic; has received research support from Siemens and Regeneron and is a shareholder in MHI Ventures. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and is a consultant (no financial compensation) for Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 20, 2019.
- Revision received September 16, 2019.
- Accepted October 10, 2019.
- 2020 American College of Cardiology Foundation
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