Comparison of the ipsi‐lateral versus contra‐lateral retrograde approach of percutaneous coronary interventions in chronic total occlusions

Abstract

In experienced hands retrograde CTO-PCI via IL CCs appears as safe and successful as the CL approach. © 2016 Wiley Periodicals, Inc.

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

“…Dautov et al assessed the safety and effectivity of the septal surfing technique in 240 retrograde PCIs, showing successful septal crossing in 81% of the cases 81. Mashayekhi et al82 compared the outcomes of retrograde CTO PCI via ipsilateral (n=44 [28%]) with contralateral (n=114 [72%]) collateral connections. The overall retrograde success was similar in the ipsilateral and contralateral group (80% versus 82%; P >0.05), with low crossover rates (ipsilateral to contralateral, 11%; contralateral to ipsilateral, 4%) and a similar major complications rate (5% versus 7%; P =1.00) 82.…”

“…Mashayekhi et al82 compared the outcomes of retrograde CTO PCI via ipsilateral (n=44 [28%]) with contralateral (n=114 [72%]) collateral connections. The overall retrograde success was similar in the ipsilateral and contralateral group (80% versus 82%; P >0.05), with low crossover rates (ipsilateral to contralateral, 11%; contralateral to ipsilateral, 4%) and a similar major complications rate (5% versus 7%; P =1.00) 82. However, epicardial collateral perforation can rapidly cause tamponade and may require urgent sealing from both directions,83 usually with coils, fat, or thrombin 84.…”

Chronic Total Occlusion (CTO): Scientific Benefit and Principal Interventional Approach

“…The main goal of all retrograde techniques is to advance successfully a coronary wire to the distal end of the CTO lesion using collateral connections originating from the contra-lateral coronary artery. Additionally, ipsilateral retrograde techniques without using contra-lateral collaterals can be applied [33,34]. Figure 3 shows schematically an occlusion of the right coronary artery (RCA) and wire positioning using epi-myocardial collateral connections to the distal end of the CTO (Figure 3A, B).…”

Ipsilateral vs. contralateral vs. no collateral (antegrade only) chronic total occlusion percutaneous coronary interventions: What is the right choice for your practice?

“…Septal perforators are the most frequently used collateral channels in retrograde CTO PCI , since their utilization is associated with lower incidence of complications such as collateral channel injury when compared with epicardial collaterals . When epicardial collaterals are utilized for the retrograde approach, contralateral collaterals are more commonly used since ipsilateral collaterals are associated with unique challenges, including wire and microcatheter advancement through steeper bends, and re‐entry into the same or a second guide catheter engaging the same coronary ostium (“ping‐pong” technique ). The retrograde approach via ipsilateral collaterals can be highly challenging, is infrequently performed, and has limited published data .…”

“…In this issue of the Journal Mashayekhi et al report techniques and outcomes of 158 retrograde CTO PCIs performed through ipsilateral ( n = 44, 28%) vs. contralateral (n = 114, 72%) collaterals by two master operators. Target lesions were highly complex with a mean J‐CTO score of 2.7.…”