Published Online
on February 20, 2009

A more recent version of this article appeared on April 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/2/124    most recent CIRCINTERVENTIONS.108.838862v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rathore, S. Articles by Suzuki, T. Search for Related Content PubMed Articles by Rathore, S. Articles by Suzuki, T. Related Collections Chronic ischemic heart disease Catheter-based coronary interventions: stents Angiography Related Article

Original Article

Retrograde Percutaneous Recannalization Of Chronic Total Occlusion Of the Coronary Arteries: Procedural outcomes and predictors of success in contemporary practice.

Sudhir Rathore¹; Osamu Katoh; Hitoshi Matsuo; Mitsuyasu Terashima; Nobuyoshi Tanaka; Yoshihisa Kinoshita; Masashi Kimura; Etsuo Tsuchikane; Kenya Nasu; Mariko Ehara; Keiko Asakura; Yasushi Asakura and Takahiko Suzuki

Toyohashi Heart Center

¹ E-mail: sudhirrathore{at}hotmail.com

Background—Retrograde approach through collaterals has been introduced for percutaneous recanalization of chronic total occlusion (CTO) of the coronary arteries. We investigated the safety and efficacy of retrograde approaches used for percutaneous recanalization of the CTO in a consecutive series of patients.

Methods and Results—We studied 157 consecutive patients who underwent retrograde CTO recanalization between 2003 and 2008 at a single center. 118 (75.2%) of these patients have had previously failed antegrade attempts. Septal, Epicardial and SVG collaterals were used in 67.5%, 24.8% and 7.6% cases respectively. Collateral channel was crossed by guide wire successfully in 115 (73.2%) cases and the procedure was successful by retrograde approach in 103 (65.6%) cases. Collateral channels (CC) were graded as: CC 0= no continuous connection; CC 1= continuous thread like connection; and CC 2= continuous, small side branch like connection. CC type 1, collateral tortuosity <90 degrees, and angle with recipient vessel <90 deg (p< 0.0001) are significant predictors of success. Whereas, epicardial channel use (p=0.01), CC type 0, corkscrew channel (p<0.0001), angle with recipient vessel >90 deg (p=0.0007) and non visibility of connection with recipient vessel were found to be significant predictors of procedural failure. The collateral channel dissection was observed in 6 patients with one needing coil embolistaion and others were managed conservatively. The MACE events were low with one CABG, one QMI, five NQMI and no deaths in this group of patients.

Conclusions—The retrograde approach in CTO PCI is effective in recanalizing CTO. The success rate by retrograde approach was 65.6% and final success was 85% in this group with acceptable overall adverse events. We have identified predictors of failure related to collateral morphology.

Key Words: angioplasty • collateral circulation • coronary disease • chronic total occlusion • retrograde

Related Article

Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries: Procedural Outcomes and Predictors of Success in Contemporary Practice

Sudhir Rathore, Osamu Katoh, Hitoshi Matsuo, Mitsuyasu Terashima, Nobuyoshi Tanaka, Yoshihisa Kinoshita, Masashi Kimura, Etsuo Tsuchikane, Kenya Nasu, Mariko Ehara, Keiko Asakura, Yasushi Asakura, and Takahiko Suzuki
Circ Cardiovasc Interv 2009 2: 124-132. [Abstract] [Full Text] [PDF]

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