European experience with the retrograde approach for the recanalisation of coronary artery chronic total occlusions. A report on behalf of the EuroCTO club

Sianos, Georgios; Barlis, Peter; Mario, Carlo Di; Papafaklis, Michail I.; Büttner, Joachim; Galassi, Alfredo Ruggero; Schofer, Joachim; Werner, Gerald S.; Lefèvre, Thierry; Louvard, Yves; Serruys, Patrick W.; Reifart, Nicolaus; Club, EuroCTO

doi:10.4244/eijv4i1a15

Cited by 165 publications

(109 citation statements)

References 24 publications

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“…To our knowledge, there have been very few reports of such long-term results for CTO lesions in the era of DES, 5 especially a comparison of the efficacy of the most widely used DES, namely SES and PES. 21, 31 None of the previous reports have compared efficacy in terms of either angiographic or clinical parameters of the 2 main types of stent in the long term (>1 year).…”

Section: Long-term Outcomes Of Des In Ctomentioning

confidence: 99%

Long-Term Clinical Outcome of Chronic Total Occlusive Lesions Treated With Drug-Eluting Stents: - Comparison of Sirolimus-Eluting and Paclitaxel-Eluting Stents -

Lee

Kim

Park

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp hronic total occlusion (CTO) of a coronary artery is present in almost one-third of patients with coronary artery disease (CAD), 1 and is a very common reason not to attempt percutaneous coronary intervention (PCI). 2 Although PCI for CTO accounts for 10 -20% of all PCI procedures, 3 and complete revascularization of the CTO is more favorable for survival than an incomplete attempt, 4,5 it has a lower success rate than for those of other de novo coronary lesions. 6 Compared with plain old balloon angioplasty, bare metal stent (BMS) implantation has shown favorable results, 7,8 but restenosis/re-occlusion resulting in target lesion revascularization (TLR) has remained a frequent and was thus a major limitation. 7-12Although drug-eluting stents (DES) have shown superior results in terms of major adverse cardiovascular events (MACE) compared with BMS in various angiographic pa-

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Section: Long-term Outcomes Of Des In Ctomentioning

confidence: 99%

Long-Term Clinical Outcome of Chronic Total Occlusive Lesions Treated With Drug-Eluting Stents: - Comparison of Sirolimus-Eluting and Paclitaxel-Eluting Stents -

Lee

Kim

Park

et al. 2010

Circ J

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“…With either approach, the collateral systems (septal or epicardial) play a vital role for visualizing and treating the target vessel. It is recommended that when contralateral collaterals exist, simultaneous bilateral injection is performed during the CTO-PCI [18]. These collateral channels may be visible or invisible angiographically and at least 50% will not allow passage to the target vessel.…”

Section: Discussionmentioning

confidence: 99%

Total aorto‐ostial chronic occlusion of the right coronary artery successfully recanalized via retrograde approach

Londoño

Singh

O’Neill

2011

Cathet Cardio Intervent

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Chronic total occlusions remain a technical challenge for interventional cardiologists. This group of lesions carries a decreased rate of success and continues to be an important reason for surgical revascularization. Recently, retrograde percutaneous coronary intervention of total occlusions via epicardial and septal perforators was introduced as an alternative approach when a previous antegrade attempt has failed. We describe a unique case where retrograde approach was used as the initial recanalization technique in the absence of a right coronary ostium.

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“…Although a retrograde approach is needed only in a minority of lesions and collateral crossing can be very time consuming and unpredictable even in the best hands, greater than 80-90 % success rates are unattainable without the addition of 15-20 % retrograde success in lesions failed anterogradely or with no anterograde options (true ostial occlusions, unidentified stump, ambiguous track). 37 In case the antegrade wire cannot be advanced through the occlusion and appears to deflect to a subintimal position, a second wire can be directed towards the distal true lumen using the first as a marker (parallel wire technique) (see Figure 2). If the wire remains in the subintimal space for a longer track distal wire reentry can be attempted guided by ultrasound or using a dedicated flat balloon with lateral ports for wire exit (Sting-Ray™, Boston Scientific, USA).…”

Section: X20 MM Balloon Is Inflated In An Atrial Branch Proximal To mentioning

confidence: 99%

New Advances in Chronic Total Occlusions

Konstantinidis

Pighi

Kılıç

et al. 2014

Interventional Cardiology Review

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Coronary CTO Coronary chronic total occlusions (CTOs) are identified in up to one third of patients with coronary artery disease referred for nonurgent coronary angiography, 1,2 with an incidence increasing with age.3 Conceptually, you may argue that the motivation to reopen a totally blocked artery is not as strong as for subocclusive lesions, that have the potential to progress and cause acute events. The evidence for coronary chronic occlusions goes into the opposite direction, suggesting that when viability and ischaemia are present reopening a coronary CTO yields a greater benefit than reopening subocclusive lesions. Data from mainly retrospective and observational series relate successful CTO recanalisation with improved survival, improvement in anginal status and left ventricular function, increased exercise tolerance and decreased need for coronary artery bypass grafting (CABG). [4][5][6][7][8] CTOs still represent the most complex lesion subset that interventional cardiologists face. Lesions with severe tortuosities, calcifications or large bifurcations present technical challenges, but the success rate in expert hands remains far above 95 %.9 With the exception of dedicated centres applying new strategies, the success rate of CTO PCI was over long period of time in the range of 60-70 %, 5 considerably lower than the success rate in non-occlusive coronary artery disease. Restenosis and reocclusion were also high before the introduction of Drug eluting stents (DES). 10 The perception that CTOs are challenging lesions with a low success rate, limited scope for revascularisation and questionable impact on patient outcome led to underutilisation of percutaneous recanalisation, with the majority of lesions left to medical therapy or referred for surgical revascularisation. No more than 10 % of all CTOs have been treated with percutaneous techniques over a long period of time. 1,3,[11][12][13][14] The following review reexamines the evidence leading to this conservative attitude and reports the advances in the treatment of CTOs, promoting a more balanced and proactive approach in patients suffering of this often highly disabling condition.

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European experience with the retrograde approach for the recanalisation of coronary artery chronic total occlusions. A report on behalf of the EuroCTO club

Cited by 165 publications

References 24 publications

Long-Term Clinical Outcome of Chronic Total Occlusive Lesions Treated With Drug-Eluting Stents: - Comparison of Sirolimus-Eluting and Paclitaxel-Eluting Stents -

Long-Term Clinical Outcome of Chronic Total Occlusive Lesions Treated With Drug-Eluting Stents: - Comparison of Sirolimus-Eluting and Paclitaxel-Eluting Stents -

Total aorto‐ostial chronic occlusion of the right coronary artery successfully recanalized via retrograde approach

New Advances in Chronic Total Occlusions

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