Different strategies of retrograde approach in coronary angioplasty for chronic total occlusion.

Background: Retrograde approach through the collateral channels has been recently proposed and has the potential to improve the success rate of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lesions of the coronary arteries.

Methods: The author performed retrograde approach for CTO lesions in 45 patients from January 2006 to January 2007 at different medical institutions worldwide. The details of the techniques were examined retrospectively.

Results: The septal branch route was used in 93% of the cases. The author classified the strategies into six types after the successful crossing of a guidewire into the target artery distal to the CTO lesion through the collateral channels. Among them, "Just landmark," "Controlled antegrade and retrograde subintimal tracking," and "Proximal true lumen puncture" strategies were used most frequently (32, 27, and 30%, respectively). The retrograde guidewires could be successfully passed distal to the CTO lesion in 37 patients (82%), among them the final PCI success was achieved in 31 patients, yielding the PCI success by pure retrograde approach of 69%. The final success rate among 45 patients including 42 patients with previous failed attempts was 84% (38 patients). There were no serious complications related to the retrograde approach.

Conclusions: Retrograde approach with different strategies, mainly through septal arteries, can provide a high success rate with PCI, as shown in 83% of patients with previous failed attempts at traditional PCI for CTO lesions, with there being no serious complications. More experience of this technique and its refinement are required for further improvement of PCI techniques for CTO lesions.