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Retrograde CTO approach boosted success rates
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A retrograde approach to treat chronic total occlusions was successful in more than 79% of patients, according to results of a study presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Researchers studied procedural outcomes of 401 patients (mean age, 65 years; 84% men) who underwent retrograde chronic total occlusion (CTO) intervention at three US institutions between 2006 and 2011. This study is the largest in the United States to examine the safety and effectiveness of the retrograde approach.
Emmanouil S. Brilakis
Major procedural complications occurred in 16 patients (4%), including on death due to intracranial bleeding, Q-wave MI, donor vessel dissections, equipment entrapment requiring coil occlusion of a ventricular septal defect, and perforations requiring pericardiocentesis or emergent surgery.
The CTO target vessel was the right coronary artery for 66% of the patient population, circumflex for 18%, left anterior descending artery for 15%, and left main artery or a bypass graft for 1%. Researchers used the retrograde approach as the primary approach for 48% of patients or after antegrade crossing failed in 52%. Collateral vessels used included septal (71%), epicardial (19%) and bypass graft (10%).
There are several variations of the retrograde technique. Researchers used the true-to-true puncture technique for 47% of cases; controlled antegrade and retrograde tracking and dissection (CART) in 12% of cases; and reverse CART in 41% of cases.
Half of the patients in the study had prior CABG, 45% were diabetic and 90% received drug-eluting stents with a mean stent length of 71 mm. Mean contrast volume was 368 mL and mean fluoroscopy time was 65 minutes.
“There is a lot of interest among interventionalists to train in chronic total occlusion interventions,” Emmanouil S. Brilakis, MD, PhD, FSCAI, Cardiology Today Intervention editorial board member and director of the cardiac catheterization laboratory at the Veterans Affair North Texas Healthcare System, said in a press release. “The retrograde technique has a very steep learning curve, but we need many more trained operators in the United States, given the number of patients and the complexity of the procedures. We hope this report stimulates more people to do this.”
For more information:
- Karmpaliotis D. Abstract A-045. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 9-12, 2012; Las Vegas.
Disclosure: Dr. Brilakis has received support from Abbott Vascular, Infraredx, St. Jude Medical and Terumo. His spouse is an employee of Medtronic.
Perspective
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Ajay Kirtane, MD, SM, FSCAI
These are somewhat specialized techniques, but they can be learned. We now see from these data — a robust dataset from experienced operators from the United States — that we can achieve success rates that are on par with some of our Japanese colleagues who have really pioneered this approach. What this means is there can now be safe and meaningful further expansion of treatment options for patients who previously would have been considered untreatable. I think these techniques need to be performed by those who are really dedicated to learning how to perform them. One of the benefits of more run-of-the-mill angioplasty is that, in general, it is a procedure that can be done safely in many locations and by many operators. The techniques described in this manuscript require further study and application, as well as dedicated programs at the centers at which they are performed. There are challenges to training in these techniques, but, like with most things, you have to first demonstrate proof of concept, which the researchers have done.
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