Retrograde recanalization of chronic total occlusions from the transradial approach; Early canadian experience

Rinfret, Stéphane; Joyal, Dominique; Nguyen, Can M.; Bagur, Rodrigo; Hui, William; Leung, Raymond; Larose, Éric; Love, Michael P.; Mansour, Samer

doi:10.1002/ccd.23140

Cited by 73 publications

(49 citation statements)

References 19 publications

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“…16 Antegrade dissection and reentry techniques using dedicated devices were used for longer lesions and optimal distal zone of reentry without significant side-branches. 18 Other complex lesions with ambiguous proximal caps and poor distal target were attempted by retrograde approach.…”

Section: What the Study Addsmentioning

confidence: 99%

“…When possible, arterial access was established via bilateral radial approach (right radial for the left main catheter and left radial for the right coronary artery catheter to optimize support), and 6F catheters were used primarily. 16 The preferred guiding catheter curves were Amplatz left (AL) 0.75 for the right coronary and extra back-up (XB) 3.5 for the left. FinecrossMG (Terumo, Tokyo, Japan) and Corsair (Asahi Intecc, Nagoya, Japan) microcatheters were generally used for antegrade and retrograde approaches, respectively.…”

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confidence: 99%

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Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Nombela‐Franco

Ureña

Jerez-Valero

et al. 2013

Circ: Cardiovascular Interventions

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102

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Background-Chronic total occlusion (CTO) recanalization is a complex and technically challenging procedure. The J-CTO score has been proposed to stratify case complexity and procedural success rates. However, the score has never been tested outside the setting of the original study. Moreover, its predictive value when using a hybrid antegrade or retrograde approach is unknown. We investigated the performance of the J-CTO score for predicting procedure complexity and success in an independent contemporary cohort. Methods and Results-A total of 209 consecutive patients who underwent CTO recanalization by a high-volume operator were included. Clinical and angiographic data were prospectively collected. The J-CTO score was applied for each patient, and discrimination and calibration were evaluated in the whole cohort, and according to the approach (antegrade 47% and retrograde 53%). Clinical and angiographic differences were noted between the original and studied cohort. The mean J-CTO score was 2.18±1.26, and successful guidewire crossing within 30 minutes and final angiographic success were 44.5% and 90.4%, respectively. The J-CTO score demonstrated good discrimination (c statistic, >0.70) and calibration (Hosmer-Lemeshow P>0.1) in the whole cohort and for antegrade and retrograde approaches. However, the final success rate was not associated with the J-CTO score. Conclusions-In this independent cohort, the J-CTO score showed good discriminatory and calibration capacity for guidewire CTO crossing within 30 minutes but it does not for final success rate. The J-CTO score helps to predict complexity of CTO recanalization, and the simplicity of the score supports the widespread use as a clinical tool. Methods Study Population and CTO ProceduresBetween January 2010 and December 2012, a total of 245 consecutive CTO PCI were performed by a single operator (S.R.). Of these, 36 (14.7%) patients were performed outside our institution and were not available for angiographic analysis. Hence, the final study population consisted of 209 patients, all patients referred for CTO PCI, without angiographic exclusion criteria. Baseline, procedural and hospitalization data were prospectively collected and entered in a dedicated database. Our institutional review committee approved prospective data collection as part of the Recherche Évaluative en Cardiologie InTervenionnelle (RÉCIT) registry, and subjects provided signed informed consent. A CTO was defined as an obstruction of a coronary artery with anterograde thrombolysis in myocardial infarction flow grade 0 that was confirmed or presumed to be ≥3 months old. 11 The duration of the CTO was estimated by clinical information or the results of previous angiography. Successful angiographic recanalization was defined as a restoration of thrombolysis in myocardial infarction flow grade 3 and residual stenosis <30% in the occluded artery. Successful procedure was defined as successful angiographic recanalization and no in-hospital major adverse cardiovascular event including death, strok...

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Section: What the Study Addsmentioning

confidence: 99%

mentioning

confidence: 99%

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Nombela‐Franco

Ureña

Jerez-Valero

et al. 2013

Circ: Cardiovascular Interventions

Self Cite

102

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“…4,5 Apart from the use of 8F sheathless catheter, the equipment employed during those procedures was at the discretion of the operator, and followed a published algorithm. 5 The occluded segment was always stented with drug-eluting stents and postdilated as needed (Figures 2C).…”

Section: Methodsmentioning

confidence: 99%

Effectiveness and Safety of the Transradial 8Fr Sheathless Approach for Revascularization of Chronic Total Occlusions

Dautov

Ribeiro

Altisent

et al. 2016

The American Journal of Cardiology

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“…Of note, the presence of antegrade predictors of failure does not impact retrograde success [4]. In this issue of our journal, Rinfret et al report a series of patients with CTOs who underwent retrograde recanalization through bilateral transradial puncture [6]. In this study, success rate was 88% (37/42).…”

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confidence: 90%

Navigating through tiny rivers

Belardi

Albertal

2011

Cathet Cardio Intervent

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There is nothing more frustrating than failing recanalization of a chronic total coronary occlusion (CTO). At the SYNTAX trial, approximately one-fourth of the studied population had CTOs and although the recanalization attempt rate was high (93%), success rate was only 53% [1]. For decades, the only route for CTO recanalization has been anterograde. Numerous advances in guidewire design and manipulation have improved recanalization rates through this route; however, success rates plateau around 70% [2]. Several predictors of antegrade failure have been identified such as operator experience and specific lesion characteristics (time duration, nontapered stump, occlusion length >20 mm, presence of severe calcification, bridging collateral, vessel tortuosity, and ostial location) [3]. Recently, the retrograde approach either as a default strategy after antegrade failure or as a primary strategy in selected cases has increased dramatically the overall success rates [4,5]. Undoubtedly, the retrograde route is a very complex one. It requires considerable operator expertise in addition to the presence of suitable septal or epicardial collaterals and the use of dedicated CTO tools [4]. Furthermore, the retrograde approach is associated with higher risk of complications and radiation exposure than the conventional antegrade route. Of note, the presence of antegrade predictors of failure does not impact retrograde success [4]. In this issue of our journal, Rinfret et al. report a series of patients with CTOs who underwent retrograde recanalization through bilateral transradial puncture [6]. In this study, success rate was 88% (37/42). Wiring collateral was feasible in 36 patients (85%), and most of them were successfully recanalized using state of the arts CTO techniques (pure retrograde crossing 29%, CART 3%, reverse CART 60% and kissing/knuckle wire 5%) through 6F guiding catheters. Importantly, the lack of back-up support expected with the use of small guiding catheters was overcome with modern CTO tools (Tornus and Corsair, both from Asahi Intec, Nagoya, Japan) and tricks (externalization of 300-mm long guidewires and anchoring techniques). As in previous series, the procedure did not lead to severe cardiovascular complications but then there is no data regarding radiation exposure, which can be expected to be high in this type of procedures.Naturally, to navigate wires through tiny and tortuous collaterals and get to open extremely complex CTOs appears glamorous and challenging to the operators. Nonetheless, the precise role of this technique is still evolving. For most cases, it appears safe to start with the conservative route. In the event of failure, retrograde recanalization can be attempted by a skill CTO operator, if clinically indicated.

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Retrograde recanalization of chronic total occlusions from the transradial approach; Early canadian experience

Abstract: Transradial retrograde CTO recanalization is feasible, safe, and still associated with high success rates despite the use of smaller guide catheters.

Cited by 73 publications

References 19 publications

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Effectiveness and Safety of the Transradial 8Fr Sheathless Approach for Revascularization of Chronic Total Occlusions

Navigating through tiny rivers

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