Abstract 15305: Difference in the Frequency of Procedural Complications Related to Percutaneous Coronary Intervention of Chronic Total Occlusions Between via Retrograde Approach vs. via Antegrade Approach. - A Toyohashi Experience-
Background: Despite recent high success rates owing to the development of new strategies such as the retrograde approach, the procedural complications and their management related percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) have not been fully evaluated.
Methods: The aim of this study was to investigate in-hospital outcomes and compare the frequency of the complications between via the retrograde approach vs. via antegrade approach. The complications included major adverse cardiac and cerebrovascular events (MACCE) (defined as death, myocardial infarction [MI], emergent coronary bypass surgery, repeat PCI, or stroke), bleeding of clinical significance, and he procedural complications such as acute or sub-acute occlusion, distal embolization, coronary dissection, and coronary perforation.
Results: Of 1,014 CTOs in 943 patients who underwent PCI between 2005 and 2010, 278 CTOs (27.6%) were attempted using the retrograde approach. The overall procedural success rate was 92.4% (937/1014). The complication was the second reason for suspended CTO procedure (7.8%; 6/77). No significant difference was observed in the frequency of the complications between antegrade approach and retrograde approach except the frequency of coronary perforation that was higher in the patients treated with retrograde approach. (Table)
Conclusions: Although the higher rate of coronary perforation in the patients treated with retrograde approach, all cases were solved with optimal treatments in the cath-lab and in-hospital MACCE was acceptable. Retrograde approach could be the one of the option for the failed case with antegrade approach.
- © 2013 by American Heart Association, Inc.