Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions

Objectives : The goal of this study was to compare the antegrade‐approach and bilateral‐approach strategies for chronic total occlusion (CTO). Background: The retrograde approach has been reported for difficult CTO lesions. Methods : This study assessed 96 consecutive patients with 119 CTO lesions. The lesions were treated with either an antegrade approach (A group) or a combined bilateral antegrade and retrograde approach (B group). The specific intervention techniques, in‐hospital success rate, and major adverse cardiac and cerebrovascular events (MACCE) were compared. Results : Lesions with well‐developed septal collaterals with nontortuous microchannels were preferentially chosen for the B group versus A group ( P < 0.001 and 0.008, respectively). Compared with the A group, there were more CTO lesions located in the right coronary artery in the B group ( P < 0.001). In the B group, the CTO lesions had a longer length and needed stiffer wires for crossing than in the A group ( P = 0.001 and 0.046, respectively). The technical success rate was 94% and 86% for the A group and the B group, respectively ( P = 0.127). In‐hospital complications were not different between the two groups. The B group needed a higher radiation exposure dose and a greater exposure time than the A group ( P < 0.001). In the B group, use of the retrograde method significantly increased the final success rate. Conclusions: These results suggest that all CTO lesions should first be managed with an antegrade approach. When there is difficulty crossing the lesion, switching to a bilateral approach is an option for lesions with well‐developed collaterals. © 2009 Wiley‐Liss, Inc.