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 CTO in a consecutive series of patients. and nonvisibility of connection with recipient vessel were found to be significant predictors of procedural failure. The CC dissection was observed in 6 patients, with 1 needing coil embolization and others who were managed conservatively. The major adverse cardiac events were low, with 1 coronary artery bypass graft, 1 Q-wave myocardial infarction, 5 non-Q-wave myocardial infarctions, and no deaths in this group of patients. Conclusions-The retrograde approach in CTO percutaneous coronary intervention 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. (Circ Cardiovasc Intervent. 2009;2:124-132.)

Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.

oronary artery disease (CAD) and its thrombotic complications are the leading cause of morbidity and mortality in the industrialized countries. Over the past 30 years, invasive coronary angiography (ICAG) has been the gold standard method for the visualization and detection of coronary stenosis. Recently, efforts have been made to develop reliable noninvasive diagnostic methods that would allow a broader use, as well as decreasing the risks linked to an invasive examination.Multislice computed tomography (MSCT), which started with a 4-slice scanner in 1998, was the beginning of visualizing the coronary arteries noninvasively, 1-9 and with the development of 16-slice MSCT, this desire has been realized to some extent. To date, many investigators have evaluated the accuracy of MSCT for detecting significant coronary stenosis and in most of the published studies the sensitivity is approximately 80% and the specificity approximately 90%. [10][11][12][13][14][15][16][17][18][19] The results appear promising, but those studies did not consist of consecutive patients, including those with unsatisfactory images for interpretation. Besides, cases with severe calcification, high heart rates (>70 beats/min), or previous revascularization, were excluded from most of the studies.In daily practice, however, we often encounter patients with advanced CAD, having severely calcified arteries, or patients who are post percutaneous coronary intervention (PCI) using different treatment modalities such as stenting, plain old balloon dilatation, or debulking.The new 64-slice MSCT (64-MSCT), which provides a 0.4 mm isotropic resolution and less than 165 ms temporal resolution, has the potential to overcome image-degrading artifacts related to motion, pixel noise, calcification or coronary stents to some extent. 20,21 The aim of our study was to evaluate the diagnostic accuracy of 64-MSCT in various types of patients, including those with severely calcified arteries or post-PCI, as Background Multislice computed tomography (MSCT) is a promising noninvasive method of detecting coronary artery disease (CAD). However, most data have been obtained in selected series of patients. The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64 MSCT) in daily practice, without any patient selection. Methods and ResultsUsing 64-slice MSCT coronary angiography (CTA), 69 consecutive patients, 39 (57%) of whom had previously undergone stent implantation, were evaluated. The mean heart rate during scan was 72 beats/min, scan time 13.6 s and the amount of contrast media 72 mL. The mean time span between invasive coronary angiography (ICAG) and CTA was 6 days. Significant stenosis was defined as a diameter reduction of >50%. Of 966 segments, 884 (92%) were assessable. Compared with ICAG, the sensitivity of CTA to diagnose significant stenosis was 90%, specificity 94%, positive predictive value (PPV) 89% and negative predictive value (NPV) 95%. With regard to 58 stented lesions, the sensitivity, specificity, PPV and NPV were 93...

Coronary septal collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTOs.

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