Recanalisation of coronary chronic total occlusion by retrograde approach: The first experience in Poland

Abstract

Background: The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach. Aim: This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach. Methods: From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach. Results: All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001). Conclusions: Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.