Long‐Term Outcomes of Successful Chronic Total Occlusion Percutaneous Coronary Interventions Using the Antegrade and Retrograde Approach

Michael, Tesfaldet T.; Mogabgab, Owen; Alomar, Mohammed; Kotsia, Anna; Christopoulos, George; Rangan, Bavana V.; Abdullah, Shuaib; Grodin, Jerrold; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1111/joic.12149

Cited by 30 publications

(24 citation statements)

References 36 publications

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“…Although the long- term implications of PMI remain the subject of debate, they were associated with worse clinical outcomes in one study [12]. Use of the retrograde approach has been associated with worse outcomes as compared with the antegrade approach in one study [1]. A recent analysis from the European Registry of CTO interventions (ERCTO) showed favorable outcomes with the retrograde approach [8].…”

Section: Discussionmentioning

confidence: 98%

“…Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has undergone remarkable evolution in both equipment and technique, resulting in high success and low complication rates [1][2][3][4]. There are three major CTO crossing strategies: [1] antegrade wire escalation, [2] antegrade dissection/re-entry, and [3] the retrograde approach.…”

Section: Introductionmentioning

confidence: 99%

“…There are three major CTO crossing strategies: [1] antegrade wire escalation, [2] antegrade dissection/re-entry, and [3] the retrograde approach. There is ongoing controversy about optimal crossing strategy selection, fueled by limited comparative data on outcomes using the currently available crossing techniques [5].…”

Section: Introductionmentioning

confidence: 99%

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Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Stetler¹,

Karatasakis

Christakopoulos

et al. 2016

Cathet Cardio Intervent

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Objectives: We sought to evaluate the impact of crossing strategy on the incidence of periprocedural myocardial infarction (PMI) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The optimal technique for crossing coronary CTOs remains controversial. Methods: We retrospectively examined the incidence of PMI among 184 consecutive patients who underwent CTO PCI at our institution between 2012 and 2015. Creatine kinase-myocardial band fraction (CK-MB) and troponin were measured before and after PCI in all patients. PMI was defined as CK-MB increase !33 upper limit of normal (ULN). Results: Mean age was 65 6 8 years, 98% of patients were men, 57% had diabetes mellitus, 36% were current smokers, 38% had prior heart failure, 31% had prior coronary artery bypass graft surgery (CABG), and 55% had prior PCI. The retrograde approach was used in 38% of cases. As compared with antegrade wire escalation and antegrade dissection/re-entry, use of the retrograde approach was associated with higher J-CTO (Multicenter CTO Registry of Japan) scores (P < 0.0001), higher frequency of moderate or severe calcification (P 5 0.0061), longer CTO length (P < 0.0001), more frequent proximal cap ambiguity (P < 0.0001), and lower technical (P 5 0.0007) and procedural (P 5 0.0014) success. The frequency of PMI for the antegrade-only and retrograde cases was 10% and 33%, respectively (P 5 0.0001). On multivariate analysis, use of the retrograde approach and moderate/severe calcification were independently associated with higher incidence of PMI. Conclusions: As compared with antegrade-only crossing techniques, the retrograde approach is used in patients with more complex anatomy but may carry higher risk for PMI. V C 2016 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Stetler¹,

Karatasakis

Christakopoulos

et al. 2016

Cathet Cardio Intervent

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“…3,[6][7][8] Crossing strategy selection depends heavily on the angiographic characteristics of the occlusion, 9 but a critical factor in clinical decision making is long-term patency. Although early reports on extensive antegrade dissection/re-entry techniques suggested high restenosis rates, 10-13 limited contemporary data have been published in this area, [14][15][16] prompting us to examine patients treated at our institution during the past 3 years, during which maturity was reached with the use of various crossing techniques.…”

mentioning

confidence: 99%

Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention

Amsavelu

Christakopoulos

Karatasakis

et al. 2016

Canadian Journal of Cardiology

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“…Current studies have shown that successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) improves the quality of life, left ventricular ejection fraction and survival rate [1][2][3][4][5][6][7][8]. The development of devices such as guide wires, balloons and stents, and the improvement of operator techniques has increased the success rates of PCI for CTO lesions and decreased the complication rates over time [9,10].…”

Section: Introductionmentioning

confidence: 99%

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

Okamoto¹,

Yasumura²,

Yasumoto³

et al. 2017

Interv Cardiol J

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Objectives: We investigated neointimal characteristics after everolimus-eluting stent (EES) implantation in chronic total occlusion (CTO) using optical coherence tomography (OCT).Background: CTO is one of the major risk factors for restenosis and reocclusion even in drug-eluting stent era, but detailed neointimal characteristics after stent implantation in CTO is unclear. Methods:We divided our patients (35 EESs) into three groups: patients with stenting for non-CTO lesions (non-CTO group), patients with subintimal stenting (CTO subintima group) and with intra true-lumen stenting for CTO lesions (CTO true lumen group). We compared OCT parameters included the percentage of neointimal hyperplasia area obstruction (%NHAO), mean neointimal hyperplasia (NIH) thickness, the proportion of uncovered struts, the proportion of malapposed struts at cross sectional level and at strut level among three groups.Results: NIH and %NHAO were significantly lowest in CTO subintima group (5 EESs) and highest in CTO true-lumen group (4 EESs) (CTO subintima vs. CTO true-lumen vs. non- , respectively) while the proportions of uncovered struts and malapposed struts were significantly highest in CTO subintima group and significantly lowest in CTO true-lumen group among the three groups (CTO subintima vs. CTO true-lumen vs. non-CTO: 109 (18.7) vs. 47 (4.7) vs. 375 (7.9) and 36 (6.2) vs. 0 (0) vs. 45 (0.95), respectively). Conclusions:We revealed by OCT that stents implanted in subintima in CTO lesions may have more risks related to stent thrombosis such as malapposed struts and uncovered struts, while stents implanted in true lumen in CTO lesions may have thicker neointimal coverage that might have occurred restenosis.

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Long‐Term Outcomes of Successful Chronic Total Occlusion Percutaneous Coronary Interventions Using the Antegrade and Retrograde Approach

Abstract: Retrograde CTO PCI was associated with higher incidence of TLR, but similar incidence of death and myocardial infarction compared to antegrade CTO PCI. These findings likely reflect the higher complexity of CTO lesions treated with the retrograde approach.

Cited by 30 publications

References 36 publications

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Impact of Crossing Strategy on Intermediate-term Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

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