Key result
Retrograde techniques for chronic total occlusion PCI are associated with increased short-term complications but similar long-term durability and patient outcomes compared to antegrade techniques.
Why the study?
As chronic total occlusion percutaneous coronary intervention has evolved, technical approaches have been refined, motivating a review of antegrade versus retrograde techniques and outcomes.
Do retrograde techniques compared to antegrade techniques improve outcomes in patients undergoing CTO PCI?
Do retrograde techniques compared to antegrade techniques improve outcomes in patients undergoing CTO PCI?
Retrograde techniques are vital for complex CTO PCI success, offering similar long-term outcomes to antegrade techniques despite potentially higher short-term complications.
May support retrograde CTO PCI in complex lesions despite short-term risks; leaves open need for RCTs to confirm outcomes.
Introduction: As the field of chronic total occlusion percutaneous coronary intervention has evolved, technical approaches have evolved and been refined.Areas covered: In this review, we discuss the major techniques utilized in modern CTO PCI including antegrade wiring, antegrade dissection reentry, retrograde wiring, and retrograde dissection reentry. Retrograde techniques have been extensively studied in comparison to antegrade techniques. Retrograde techniques have contributed to increases in CTO PCI success rates and are generally used in higher complexity lesions. Observational data ssuggestincreased sshort-termcomplications in procedures requiring the use of retrograde techniques; however, llong-termCTO PCI durability and patient outcomes have been shown to be similar among procedures using antegrade only versus retrograde techniques.Expert opinion: Retrograde techniques play a vital role in the technical success of CTO PCI, particularly among more complex lesions and in patients with high burdens of comorbidities. Increases in procedural safety with equipment iteration and in the use of adjunctive imaging will play an important role in the selection of appropriate retrograde conduits and the overall success rates of CTO PCI.
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Kunkel et al. (2021) conducted a review in Chronic Total Occlusions (CTO). Retrograde techniques vs. Antegrade techniques was evaluated. Retrograde techniques for chronic total occlusion PCI are associated with increased short-term complications but similar long-term durability and patient outcomes compared to antegrade techniques.
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