Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions

Surmely, Jean‐François; Katoh, Osamu; Tsuchikane, Etsuo; Nasu, Kenya; Suzuki, Takahiko

doi:10.1002/ccd.20816

Cited by 149 publications

(113 citation statements)

References 11 publications

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“…6) Moreover, novel devices and technique developments such as retrograde approach, contralateral injection, anchoring techniques, tapered-tip guidewires, and more flexible microcatheters have dramatically improved the success rates of the TR approach for CTOs. [7][8][9][10] A rare case of congenital anomalous coronary origin was found during coronary angiography (< 1%). TR PCI for a CTO without a stump in an RCA with a high anterior takeoff and downward course is one of the most technically challenging cases for interventionists.…”

Section: Discussionmentioning

confidence: 99%

Successful Transradial Antegrade Coronary Intervention of a Rare Right Coronary Artery High Anterior Downward Takeoff Anomalous Chronic Total Occlusion by Double-Anchoring Technique and Retrograde Guidance

Fang

2009

Int. Heart J.

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SummaryPercutaneous coronary intervention (PCI) via a transradial approach has become feasible for the treatment of chronic total occlusion (CTO). However, abnormalities such as anomalous origin coronary arteries represent the most technically challenging cases for interventional cardiologists. In this case, we describe a CTO in a rare anomalous right coronary artery (RCA) that originated from a high anterior takeoff with downward direction; transradial recanalization was the second attempt at RCA CTO and was successfully performed by employing a double-anchoring technique with an antegrade and retrograde approach. (Int Heart J 2009; 50: 531-538) Key words: Percutaneous coronary intervention, Right coronary artery chronic total occlusion, Anomaly of right coronary artery, Retrograde guidance, Anchoring technique CHRONIC total occlusions (CTOs) are believed to be the most challenging lesions encountered by interventional cardiologists. 1) Successful recanalization in patients with viable myocardium has been shown to reduce symptoms like angina, decrease the need for surgery, and improve survival.2-3) Coronary artery anomalies have been found in 1% of the general population who underwent diagnostic coronary angiography. 4) Coronary intervention for an anomalous coronary artery is a technically challenging and extremely complicated procedure, especially in cases of a transradial (TR) approach for CTOs without a stump. 5)Here, we describe a rare case of a CTO in the proximal portion of an anomalous right coronary artery (RCA) that originated from a high anterior takeoff and progressed in the downward direction. This second attempt at RCA CTO was From the

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Section: Discussionmentioning

confidence: 99%

Successful Transradial Antegrade Coronary Intervention of a Rare Right Coronary Artery High Anterior Downward Takeoff Anomalous Chronic Total Occlusion by Double-Anchoring Technique and Retrograde Guidance

Fang

2009

Int. Heart J.

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“…Retrograde approach has been described initially via the bypass grafts 20 and more recently the use of septal collaterals has been described 18 to be safe and effective. Retrograde approach for recanalization of CTO has gained popularity recently with improved success rates as shown in several case reports and small series of selected patients.…”

Section: Clinical Perspective See P 132mentioning

confidence: 99%

“…The technique of retrograde approach has evolved over time with accumulating experience and emergence of dedicated devices. We have previously described the use of septal CCs and technique of controlled antegrade and retrograde subintimal tracking (CART) 18,19 to facilitate this procedure.…”

Section: Retrograde Procedural Details Procedural Techniquementioning

confidence: 99%

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Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries

Rathore

Katoh

Matsuo

et al. 2009

Circ: Cardiovascular Interventions

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219

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Background-Retrograde approach through collaterals has been introduced for percutaneous recanalization of chronic total occlusion (CTO) of the coronary arteries. We investigated the safety and efficacy of retrograde approaches used for percutaneous recanalization of CTO in a consecutive series of patients. and nonvisibility of connection with recipient vessel were found to be significant predictors of procedural failure. The CC dissection was observed in 6 patients, with 1 needing coil embolization and others who were managed conservatively. The major adverse cardiac events were low, with 1 coronary artery bypass graft, 1 Q-wave myocardial infarction, 5 non-Q-wave myocardial infarctions, and no deaths in this group of patients. Conclusions-The retrograde approach in CTO percutaneous coronary intervention is effective in recanalizing CTO. The success rate by retrograde approach was 65.6%, and final success was 85% in this group with acceptable overall adverse events. We have identified predictors of failure related to collateral morphology. (Circ Cardiovasc Intervent. 2009;2:124-132.)

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“…We reported that the prevalence of tapered pattern was significantly more frequent in distal lumen compared to proximal lumen (11). The utilization of retrograde approach is one of the main advances in revascularization techniques during CTO procedures and is responsible for the incremental success rates (6,20).…”

Section: Proximal and Distal Lumen Patternmentioning

confidence: 99%

Pathology of Coronary Chronic Total Occlusion

Sakakura

Yahagi

Virmani

2016

Int Cardiovasc Res J

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There is an increasing need for percutaneous revascularization procedures of coronary Chronic Total Occlusion (CTO), because many patients with severe coronary artery disease have limited options for revascularization. Although the success rate of percutaneous revascularization of CTOs was unsatisfactory from the 1990s to the 2000s, recent technological advances in interventional strategies have improved the success rate to 85%. Detailed histological assessment of human autopsy studies of CTO has contributed significantly to the refinement in Percutaneous Coronary Intervention (PCI) techniques and device development. We have recently reported the pathological findings and characteristics of CTOs that occur in different clinical scenarios. In this review, we discuss the pathology of CTOs to facilitate greater understanding of revascularization strategies for CTOs.

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Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions

Abstract: Coronary septal collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTOs.

Cited by 149 publications

References 11 publications

Successful Transradial Antegrade Coronary Intervention of a Rare Right Coronary Artery High Anterior Downward Takeoff Anomalous Chronic Total Occlusion by Double-Anchoring Technique and Retrograde Guidance

Successful Transradial Antegrade Coronary Intervention of a Rare Right Coronary Artery High Anterior Downward Takeoff Anomalous Chronic Total Occlusion by Double-Anchoring Technique and Retrograde Guidance

Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries

Pathology of Coronary Chronic Total Occlusion

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