Chronic Total Coronary Artery Occlusion Recanalization with Percutaneous Coronary Intervention Using Anterograde and Retrograde Approach – Riga East Clinical University Hospital Experience

Abstract

17Summary Introduction. Despite advantages in interventional cardiology during last decade, chronic total occlusions (CTO) still remains one of the biggest problem in percutaneous coronary interventions (PCI) (10,14). CTO prevalence is high, but only less than 10% of percutaneous revascularizations are CTO interventions (17). There are no prospective randomized trials, properly powered for hard clinical endpoints, comparing modern optimal medical therapy with contemporary state of the art CTO recanalization (6). Aim of the study. The aim of our study was to compare CTO PCI procedural parameters and treatment results using anterograde and/or retrograde approach. Materials and methods. The study included all patients undergoing PCI for CTO at single tertiary PCI center between January 2007 and December 2012. 5568 PCI procedures were done in this period in our institution. 486 (8,64%) of them were CTO PCI. Retrograde approach was used in 138 (28,7% of all CTO PCI) cases. Patients were grouped according PCI year performing, approach (anterograde or retrograde) and PCI results (successful or unsuccessful). Demographic and procedural data were collected at the time of intervention. Results. A total of 405 patients undergoing CTO PCI were included. The median age was 64yrs(38-88) and 79,2% was male. Retrograde approach (RA) was used in 138(28,7%) cases. RA usage has increase from 15.9% in 2007 till 46,8% of cases in 2012(p=0,0000218). The overall patient and procedure success rates were 77,8% (315/90) and 69,9%(340/146) respectively. Overall success rate has increase from 61,4% in 2007 till 87,1% in 2012 (p<0,001). Overall survival was found better in patients group after successful procedure (Long-rank test p=0,019). Conclusions. Retrograde approach usage significantly increase CTO PCI success rate, but doesn't increase risk of complications. Long-term outcome and survival after CTO PCI is not depending on approach (anterograde or retrograde), but on procedural success.

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

“…3). These results coincide with data obtained in our hospital in 2013 in a shorter observation period (Kalnins et al, 2013). …”

Case Report: RETROGRADE APPROACH FOR CTO LESIONS: SERIAL CASE

“…Patients with CTO may appear with the presentation of stable angina, silent ischemia, heart failure due to ischaemia, while on the other hand there are CTO patients who are discovered accidentally. The benefits of the opening of the artery occlusion are, among others, improvements of angina complaints, an increase in left ventricular function, avoid bypass surgery as well as increasing life expectancy (Kalnins 2013, George 2014.…”

“…Indications of CTO recanalization was the same with indications on the stenotic lesion is that when angina or ischemia are obtained caused by arterial territories that experienced CTO (Kalnins 2013, Saito 2008, Windecker et al 2014. In patients with no symptoms or symptoms controlled by medication, it is important to do a sensitive noninvasive provocation test for the presence of ischemic area (Mario 2007).…”

“…In patients with no symptoms or symptoms controlled by medication, it is important to do a sensitive noninvasive provocation test for the presence of ischemic area (Mario 2007). CTO with myocardial necrosis were already at the distal lesion revascularization performed PCI because the action will not provide a lot of changes (Kalnins 2013, Saito 2008, Windecker et al 2014.…”

Recanalization of chronic total coronary occlusions—high success rate despite a restrictive use of the retrograde approach

“…In a recently published multicenter CTO registry a retrograde approach was used in 34% of all procedures , in some centers up to 50% , in almost half of them as a first‐line intervention. This strategy results in a success rate of up to 90%.…”