The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes
Authors' conclusion
Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest.
Study context
- Population
- Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCIs) at 44 centres, 2012–2023
- Participants
- 4,058 retrograde CTO PCIs
Methodological detailsmulticentre (44 centres)
- Multicentre (44 centres)
Main finding
As reported in the abstract
Technical success
78.7%
Procedural success
76.6%
Retrograde crossing successful
60.5%
Lesion crossing successful
81.6%
Observational data: associations, not effects.
Further findings
Mean J-CTO score
- Mean J-CTO score (± SD)
- 3.1 ± 1.1
Collateral pathways successfully used
- Septals
- 62.0%
- Saphenous vein grafts
- 17.4%
- Epicardials
- 19.1%
Technical success with antegrade approach after failed retrograde crossing
- Technical success
- 50.3%
Safety
In-hospital major adverse cardiac events (MACE) (death, MI, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, stroke)
- In-hospital MACE
- 3.5%
Clinical coronary perforation
- Clinical coronary perforation
- 5.8%
In-hospital MACE by retrograde crossing strategy
- Retrograde true lumen crossing
- 2.1%
- Just marker antegrade crossing
- 0.8%
- Conventional reverse controlled antegrade and retrograde tracking (CART)
- 5.5%
- Contemporary reverse CART
- 3.0%
- Extended reverse CART
- 2.1%
- Guide-extension reverse CART
- 3.2%
- CART
- 4.1%
- P = 0.01
Original publication
Summarised from the published abstract; every number is checked against it