Original Title: Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry.

Reference: Dimitri Karmpaliotis et al. Circ Cardiovasc Interv. 2016 Jun;9(6).

This study evaluated the safety and efficacy of the retrograde technique for chronic total occlusions. Researchers compared retrograde vs. anterograde technique outcomes in 1,301 procedures from 11 experienced centers across the US between the years 2012 and 2015.

Population mean age was 65.5±10 years with high diabetes prevalence (45%) and prior MI revascularization surgery (34%).

Globally, technical success was 90%, which reflects the experience of these centers, and major cardiovascular adverse events rate was 2.4%.

The retrograde technique was used in 539 cases (41%), both as initial strategy (46%) and after a failed anterograde attempt (54%).

Comparing both techniques, the retrograde technique was used in more complex cases, both from the clinical (prior surgery 48% vs. 24%; p<0.001) and angiographic point of views (mean Japan CTO score 3.1±1.0 vs 2.1±1.2; p<0.001) and resulted in lower technical success (85% vs. 94%; p<0.001) and higher complications rate (4.3% vs 1.1%; p<0.001).

Multivariable analyzis showed that the presence of suitable collaterals, no prior CABG and the left anterior descending artery as target vessel were success predictors for the retrograde technique.

Conclusion

The retrograde approach is commonly used in the daily contemporary practice especially on most challenging lesions and patients. Despite lower success and higher complications rates compared to the anterograde technique, it is an essential tool to maintain high success rates in chronic total occlusions.

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