Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions

• Published in: Catheterization and cardiovascular interventions Vol. 74; no. 4; pp. 555 - 563
• Main Authors: Hsu, Jen Te, Tamai, Hideo, Kyo, Eisho, Tsuji, Takafumi, Watanabe, Satoshi
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-10-2009
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - methods; antegrade approach; Cerebrovascular Disorders - etiology; Chronic Disease; chronic total occlusion; Collateral Circulation; Coronary Angiography; Coronary Circulation; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - physiopathology; Coronary Occlusion - therapy; Feasibility Studies; Female; Heart Diseases - etiology; Humans; Male; Middle Aged; Patient Selection; Radiation Dosage; retrograde approach; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.22035

Objectives: The goal of this study was to compare the antegrade‐approach and bilateral‐approach strategies for chronic total occlusion (CTO). Background: The retrograde approach has been reported for difficult CTO lesions. Methods: This study assessed 96 consecutive patients with 119 CTO lesions. The lesions were treated with either an antegrade approach (A group) or a combined bilateral antegrade and retrograde approach (B group). The specific intervention techniques, in‐hospital success rate, and major adverse cardiac and cerebrovascular events (MACCE) were compared. Results: Lesions with well‐developed septal collaterals with nontortuous microchannels were preferentially chosen for the B group versus A group (P < 0.001 and 0.008, respectively). Compared with the A group, there were more CTO lesions located in the right coronary artery in the B group (P < 0.001). In the B group, the CTO lesions had a longer length and needed stiffer wires for crossing than in the A group (P = 0.001 and 0.046, respectively). The technical success rate was 94% and 86% for the A group and the B group, respectively (P = 0.127). In‐hospital complications were not different between the two groups. The B group needed a higher radiation exposure dose and a greater exposure time than the A group (P < 0.001). In the B group, use of the retrograde method significantly increased the final success rate. Conclusions: These results suggest that all CTO lesions should first be managed with an antegrade approach. When there is difficulty crossing the lesion, switching to a bilateral approach is an option for lesions with well‐developed collaterals. © 2009 Wiley‐Liss, Inc.