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Retrograde revascularization method successful; training demanding
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The retrograde approach to recanalization of chronic total occlusions, although a complex and demanding technique, was found to have a high success rate when done at a single center by highly experienced operators.
Researchers of the study examined a retrograde percutaneous technique for CTO in 40 patients from a single-center retrospective registry that enrolled from January 2008 to October 2011 at Clinic of Cardiology, Clinical Center of Serbia, Belgrade.
Septal collaterals were used to access the occlusion in all cases. Retrograde guidewire crossing of collateral channels was successful in 90% of patients with a success rate of 97.2%.
Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5%. Total in-hospital MACE rate was 5% among two patients with non–Q-wave MIs. MACE-free survival at median follow-up of 20 months was 89% (95% CI, 78-100).
Among each strategy, the success rates were 87% when the retrograde approach was performed as the primary strategy; 87.5% for retrograde immediately after antegrade failure; and 88.9% for retrograde after previous failed antegrade attempt.
Because the procedure is complex, the researchers said training and proctorship are required for a high success rate.
“A learning curve and success of the program regarding retrograde approach in CTO PCI is indisputable and dependent on enthusiasm, dedication, persistence and support from local environment and management. On practical level, careful patient selection and analysis, operator experience, material and specific technique utilized, as well as management of complications are true predictors of the success of the procedure,” they wrote.
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