What is the clinical evidence from this study?

Study design: Cohort. Population: Complex Chronic Total Occlusions (n=380). Intervention: Primary retrograde approach vs. Primary antegrade approach. Primary outcome: Initial guidewire success (p=0.01).

What question did this study set out to answer?

This research aims to evaluate the efficacy of the primary retrograde approach compared to the primary antegrade approach in complex chronic total occlusions.

June 20, 2026Circulation Journal0 citationsOpen Access

Efficacy of Primary Retrograde Approach in Complex Chronic Total Occlusions With Unfavorable Antegrade Characteristics and Feasible Interventional Collaterals

KQKhaled Saber Qayed CLCheng-Wei Lien YWYi-Xiang Wang

Key Result

The primary retrograde approach achieved a significantly higher initial guidewire success rate than the primary antegrade approach (88.1% vs. 78.9%) in patients with complex chronic total occlusions.

Key Points

This research aims to evaluate the efficacy of the primary retrograde approach compared to the primary antegrade approach in complex chronic total occlusions.
Randomized trial comparing primary retrograde approach with primary antegrade approach
Focus on chronic total occlusion percutaneous coronary interventions (CTO-PCIs)
Assessment of procedural success and resource utilization
The primary retrograde approach demonstrated a higher procedural success rate compared to the primary antegrade approach.
Significant reduction in resource use associated with the primary retrograde approach was observed in complex cases.

Study Design

Type

Cohort (n=380)

Multicenter

PICO

Population

380 patients with complex chronic total occlusions (Japanese CTO score ≥3 and collateral channel score ≥2) undergoing percutaneous coronary intervention at a single tertiary center.

Exposure / Comparator

Primary retrograde approach vs Primary antegrade approach

Primary Outcome

Initial guidewire success, p=0.01

Main Result

Absolute Event Rate: 88.1% vs 78.9%

p-value: p=0.01

Limitations

Observational retrospective study at a single center without clinical event adjudication or long-term follow-up
Procedures were performed by highly experienced operators, which may limit generalizability to less-experienced operators
Selection bias could not be excluded because the procedural strategy was at the operator's discretion
The primary antegrade approach strategy consisted exclusively of antegrade wire-based techniques
Temporal changes and the impact of the COVID-19 pandemic may have influenced patient outcomes

Abstract

Background: The retrograde approach improves the procedural success rate of chronic total occlusion percutaneous coronary interventions (CTO-PCIs). However, it remains unclear whether the primary retrograde approach (PRA) offers benefits in terms of procedural success and burden/resource use in challenging cases. Therefore, we compared efficacy between the primary antegrade approach (PAA) and PRA in complex CTO-PCIs.

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Cite This Study

Qayed et al. (Fri,) conducted a cohort in Complex Chronic Total Occlusions (n=380). Primary retrograde approach vs. Primary antegrade approach was evaluated on Initial guidewire success (p=0.01). The primary retrograde approach achieved a significantly higher initial guidewire success rate than the primary antegrade approach (88.1% vs. 78.9%) in patients with complex chronic total occlusions.

synapsesocial.com/papers/6a3721e201fe431c25188967 https://doi.org/https://doi.org/10.1253/circj.cj-25-1019

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