Abstract 4462: A Retrograde Approach for Treating Re-Attempted Lesions with Chronic Total Occlusions: Sub Analysis of the CART Registry
Background: The recanalization of chronic total occlusions (CTOs) in native coronary arteries no doubt represents one of the most technically challenging of interventional procedures. The acute result of a CTO procedure has a significant impact on long-term outcomes. Despite recent developments in dedicated materials and new strategies for the percutaneous treatment of CTOs, the overall success rate is still not optimal, with a revascularization failure rate of approximately 20%.
Methods: The aim of this study was to evaluate the safety and feasibility of a retrograde approach for treating re-attempted lesions with CTOs in the prospective multicenter Controlled Antegrade and Retrograde subintimal Tracking (CART) registry, which enrolled a total of 224 consecutive patients. Without attempting an antegrade recanalization, the retrograde approach was attempted via collateral channels in all cases.
Results: Of 224 CTO lesions (>3 months in duration) undergoing attempted recanalization via the retrograde approach, 145 cases (64.7%) had undergone a previous CTO recanalization attempt via the antegrade approach. A history of prior myocardial infarction (MI) was present in 62% of the patients. CTO lesions were most frequently located in the right coronary artery (72%) followed by the left anterior descending artery (26%) and the left circumflex artery (2%). Successful recanalization was achieved in 96% of patients, with a procedural success rate of 94%. The CART technique was used in 87 (60%) of the cases, with successful wire and balloon delivery through the collateral channels. During the index hospitalization, the rate of in-hospital major adverse cardiovascular events was 2.0% with no cardiac deaths (Q-wave and non-Q wave MI rates were 0.7% and 1.3%, respectively).
Conclusions: A retrograde approach for re-attempted CTO lesions using the CART technique is feasible, safe, and has a higher success rate than previous approaches. The retrograde approach is an important option for failed cases with complex CTO lesions.