Background We sought to examine the efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the retrograde approach. Methods and Results We compared the outcomes of the retrograde vs. antegrade-only approach to CTO PCI among 1,301 procedures performed at 11 experienced US centers between 2012 and 2015. Mean age was 65.5±10 years and 84% of the patients were men with a high prevalence of diabetes mellitus (45%) and prior coronary artery bypass graft surgery (CABG, 34%). Overall technical and procedural success rates were 90% and 89%, respectively, and in-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). The retrograde approach was employed in 539 cases (41%), either as the initial strategy (46%) or after a failed antegrade attempt (54%). As compared with antegrade-only cases, retrograde cases were significantly more complex, both clinically (prior CABG prevalence: 48% vs. 24%, p<0.001) and angiographically (mean J-CTO score: 3.1±1.0 vs. 2.1±1.2, p<0.001) and had lower technical success (85% vs. 94%, p<0.001) and higher MACE (4.3% vs. 1.1%, p<0.001) rates. On multivariable analysis, the presence of suitable collaterals, no smoking, no prior CABG and left anterior descending artery target vessel were independently associated with technical success using the retrograde approach. Conclusions The retrograde approach is commonly used in contemporary CTO PCI, especially among more challenging lesions and patients. While associated with lower success and higher MACE rates in comparison to antegrade-only crossing, retrograde PCI remains critical for achieving overall high success rates.

MR imaging demonstrates abnormalities of the rhinencephalon present in KS patients and occasionally absent in IHH patients.

Background We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR). Methods We examined outcomes of ADR among 1,313 CTO PCIs performed at 11 US centers between 2012-2015. Results 84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9 %). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8±1.2 vs. 2.4±1.2, p<0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p=0.005) and procedural success (85.0% vs. 90.7%, p=0.002), but similar risk for MACE (2.9% vs. 2.2%, p=0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p<0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p=0.43) procedural success (91.8% vs. 94.1%, p=0.23), and MACE (2.1% vs. 0.6%, p=0.12). Conclusions ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.