中华医学杂志（英文版）2010，Vol.123Issue(7)：857-863,7.DOI:10.3760/cma.j.issn.0366-6999.2010.07.018
Retrograde approach for the recanalization of coronary chronic total occlusion: preliminary experience of a single center
Retrograde approach for the recanalization of coronary chronic total occlusion: preliminary experience of a single center
GE Lei 1XU Shi-kun 1ZHANG Feng 1WANG Xiang-fei 1WANG Qi-bing 1FAN Bing 1YAN Yan 1FENG Qi 1WANG Hao 1SHEN An 1ZHU Ming-hui 1QIAN Ju-ying 1GE Jun-bo 1LIU Xue-bo 1QIN Qing 1CUI Shan-jing 1YAO Kang 1SHEN Li 1MA Jian-ying 1HUANG Dong1
作者信息
- 1. Department of Cardiology, Zhongshan Hospital, Fudan University,Shanghai Institute of Cardiovascular Diseases, Shanghai 200032,China
- 折叠
摘要
Abstract
Background The success rate of antegrade approach for chronic total occlusions (CTO) recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. This report aimed to describe our experience of retrograde recanalization for CTO, focusing on its safety and feasibility. Methods We identified 42 patients who underwent revascularization in CTO with retrograde approach from July 2005 to November 2009 in our center.Results Three kinds of strategy were applied: retrograde as primary strategy (50.0%), retrograde immediately after antegrade failure (26.2%) and repeat procedure after previous antegrade failure (23.8%). Septal collaterals were more frequently used as the retrograde access route (92.9%). Overall success rate was 88.1%. In patients with successful retrograde wire crossing collateral channel to the distal cap of CTO, the success rate of recanalization was 94.1%. In patient with failure to cross the collaterals, the success rate was 62.5%. Eight different kinds of retrograde techniques were used: kissing wire technique (35.3%), wire trapped and reverse wire trapped technique (17.6%), back-end balloon and microcatherer reversal technique (14.7%), controlled antegrade and retrograde subintimal tracking (CART) technique (8.8%), reverse CART and modified reverse CART technique (8.8%), retrograde wire crossing technique (2.9%). There were 4 complications occurred without in-hospital major adverse cardiac events (MACE). In-hospital MACE was 7.7%. All of them were non-Q wave myocardial infarction. There were no cases of death or target vessel revascularization, either surgery or percutaneous.Conclusions The retrograde approach can be an effective tool for increasing the success rate of recanalization in the very complex CTO. To ensure the success and safety of the approach, careful case selection and device handling by experienced operators is essential.关键词
chronic total occlusions/retrograde/collaterals/percutaneous coronary interventionKey words
chronic total occlusions/retrograde/collaterals/percutaneous coronary intervention引用本文复制引用
GE Lei,XU Shi-kun,ZHANG Feng,WANG Xiang-fei,WANG Qi-bing,FAN Bing,YAN Yan,FENG Qi,WANG Hao,SHEN An,ZHU Ming-hui,QIAN Ju-ying,GE Jun-bo,LIU Xue-bo,QIN Qing,CUI Shan-jing,YAO Kang,SHEN Li,MA Jian-ying,HUANG Dong..Retrograde approach for the recanalization of coronary chronic total occlusion: preliminary experience of a single center[J].中华医学杂志（英文版）,2010,123(7):857-863,7.
