Author + information
- Alfredo R. Galassi1,
- George Sianos2,
- Nicolaus Reifart3,
- Marine Castaing4,
- Javier Escaned5,
- Francesco Marza6,
- Salvatore D. Tomasello7,
- Carlo Di Mario8,
- Gerald Werner9,
- EURO CTO10
The aim of this study was to describe the five-year European experience of retrograde percutaneous coronary interventions (PCI) revascularization for complex chronic total occlusions (CTOs) of coronary arteries.
Retrograde approach increases the success rate of percutaneous recanalization of complex CTOs of coronary arteries.
Demographic data, procedural outcomes and in-hospital clinical events were collected on 1582 consecutive lesions of 1395 patients enrolled between January 2008 and December 2012 having retrograde CTO PCI at 44 European medical centers by 45 experienced interventionalist operators. A revision of J-CTO score proposed for antegrade lesions was used to better describe success according to lesion difficulty.
Patients mean age was 62.0±10.4 years, 88.5% were men, 17.6% had prior coronary artery bypass surgery. The CTO target vessel was the right coronary artery (70.4%), circumflex (7.8%), left anterior descending artery (20.3%), and left main artery or by-pass graft (1.5%). The retrograde approach was used after prior failed attempt in 43.5% of cases. During the procedure the retrograde approach was used as first line strategy in 76.2% of cases, while immediately after antegrade failed approach in 23.8% of cases. Retrograde collateral vessels were septal (62.7%), epicardial (13.4%), by-pass graft (3.9%) or missing information (20.0%). Technical success was 75.3% (n=1.191). The mean contrast volume and fluoroscopy time were 396.3±171.3 ml and 69.8±34.1 mins, respectively. A major complication occurred in 16 patients (1.0%). In multivariable analysis, age of the patient (per 10-year increase), lower operator volume (<50, 50-100, >100), increased J-CTO score were significantly associated with increased technical failure, (p=0.01, p<0.001, p<0.001), respectively.
In Europe among selected centers dedicated to CTO revascularization, retrograde approach was performed over a 5-year period in 16.5% of these patients. The number of retrograde procedures were exponentially increasing during the last 2 years and were associated with high success and low major complications rates.
↵∗ Indicates iMPACT Trial Accepted for Oral Presentation