Contemporary retrograde approach for the recanalisation of coronary chronic total occlusion: on behalf of the Japanese Retrograde Summit Group

Abstract

Wider application of retrograde CTO PCI achieved a high rate of success in recanalisation with an acceptable rate of complications in Japan.

Retrograde Approach for Chronic Total Occlusion Percutaneous Coronary Intervention

“…1 The retrograde approach was pioneered and developed in Japan, where this technique has been demonstrated to be feasible and effective (technical retrograde success 70%, procedural success 84%), while being also safe (major adverse cardiac events <2%). 2,3 This promising technique has been applied soon in the other countries, and data on the reproducibility of Japanese outcomes in other settings have been reported, showing similar positive results. 4 The largest experience with the retrograde approach has been recently published by the European Registry of Chronic Total Occlusion (ERCTO) group, reporting in-hospital and at-follow-up outcomes associated with retrograde CTO PCI in 1582 lesions treated from 2008 to 2012 in 44 European hospitals.…”

Clinical Prediction Score for Successful Retrograde Procedure in Chronic Total Occlusion Percutaneous Coronary Intervention

“…Although specialized devices that are currently being developed might effectively improve the success rate of guide-wire crossing via the retrograde approach (e.g. Corsair, found to be significant contributor), these were not selected for the statistical analysis [12,13]. Consequently, the predictive score, obtained from Werner's CC score, the tortuous collateral and the diameter of the distal CTO lesion, was simple and applicable in clinical practice.…”

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

“…Similar to ADR, the retrograde approach is an essential tool for achieving high CTO PCI success rates,74, 75, 76 especially in more complex cases and when antegrade crossing strategies are not feasible or fail to achieve crossing 25, 27. However, the retrograde approach carries higher risk for procedure‐related complications.…”

“…However, the retrograde approach carries higher risk for procedure‐related complications. Results of the largest retrograde CTO PCI registries (>300 cases) published to date are summarized in Table 4 74, 75, 76, 77, 78. Careful selection of collateral channels is essential for optimizing the success and safety of the retrograde approach.…”

“…Saphenous vein grafts80 and septal collaterals are the preferred pathways for retrograde crossing, because they are easier to cross and carry lower risk for complications 74, 76, 79. 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.…”