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Favorable outcomes observed for retrograde CTO PCI after prior CABG
Results of a recent study have suggested that retrograde chronic total occlusion PCI yields favorably high success and low complication rates after prior CABG.
Researchers examined outcomes from 462 consecutive retrograde CTO interventions performed between 2006 and 2011 to determine the safety and efficacy of retrograde CTO interventions among three experienced US centers (rural, metropolitan and VA settings).
Technical success — defined as successful CTO recanalization by any method resulting in more than 50% residual diameter stenosis within the treated segment and restoration of TIMI grade 3 antegrade flow — was 81.4% (n=376). Procedural success, which was defined as technical success without major complications, was 79.4% (n=367). The mean contrast volume was 345 ± 177 mL and the mean fluoroscopy time was 61 ± 40 minutes. Twelve patients experienced a major complication (2.6%).
The technical success rate for primary retrograde approach was 83.4% vs. 79.7% for retrograde attempts after antegrade crossing failure (P=.34). Compared with successful lesion treatment, technical failure was associated with reduced left ventricular function.
According to the researchers, repeat surgical coronary revascularization can sometimes carry prohibitive risk or is oftentimes unsuitable, given occlusion of a vein graft to the CTO target vessel with preserved patency of the internal mammary graft.
“In some instances, native coronary CTO PCI may be preferred in the setting of patent but degenerative saphenous vein bypass grafts. Considering the risk of periprocedural complications and eventual vein graft failure, native coronary PCI may be associated with more favorable outcome than bypass graft PCI,” they wrote.
Disclosure: Karmpaliotis has served on the speakers’ bureaus of Abbott Vascular and Medtronic and as a consultant to BridgePoint Medical.