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Comparison of the ipsi‐lateral versus contra‐lateral retrograde approach of percutaneous coronary interventions in chronic total occlusions
Author(s) -
Mashayekhi Kambis,
Behnes Michael,
Valuckiene Zivile,
Bryniarski Leszek,
Akin Ibrahim,
Neuser Hans,
Neumann FranzJosef,
Reifart Nicolaus
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26611
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , surgery , angioplasty , percutaneous , cardiology , myocardial infarction
Background Retrograde recanalization of coronary chronic total occlusions (CTO) via contralateral (CL) collateral connections (CCs) is successful in 60–70% of patients in whom conventional antegrade approach fails or is unpromising. This study describes our experience with retrograde CTO‐PCI via ipsi‐lateral (IL) CCs in patients with unfavorable CL CCs. Methods Between January 2013 and September 2015, 392 consecutive CTO procedures were performed by two high volume CTO‐operators and the relevant data were fed into an online registry (ERCTO® EuroCTO‐club). Most patients (222/392; 57%) were approached antegradely, whereas 43% were attempted retrogradely (170/392). After exclusion of all procedures performed via bypass‐grafts ( n = 12), PCI via CL CCs, the CL‐group ( n = 114/158; 72%), was compared with the IL‐group that was attempted via IL CCs ( n = 44/158; 28%). Results Both groups were similar with respect to risk factors and morphologic criteria of CTO‐severity. The initial primary strategy was successful in 78% in the CL‐group and in 68% in the IL‐group. In both patient groups, the initial strategy had to be switched in five patients from CL toward IL (4.4%, n = 5/114) and from IL to CL (11.3% n = 5/44). The rate of major complications was 7% (CL) and 5% (IL), respectively (n.s.). After retrograde failure and cross‐over to an antegrade controlled re‐entry strategy the overall success rates increased to 92% (CL) and 93% (IL). Conclusions In experienced hands retrograde CTO‐PCI via IL CCs appears as safe and successful as the CL approach. © 2016 Wiley Periodicals, Inc.