Key result
Rotational atherectomy in retrograde CTO-PCI yielded similar technical success to the anterograde approach, with a trend toward higher procedural complications (P=0.054).
Why the study?
Severe plaque calcifications in coronary CTOs often require a retrograde approach and lower PCI success rates, but the feasibility, safety, and efficacy of rotational atherectomy in retrograde CTO-PCI remain unknown.
Does the retrograde approach compared to the anterograde approach affect safety and efficacy in patients undergoing rotational atherectomy during CTO-PCI?
Cohort (n=129)
Does the retrograde approach compared to the anterograde approach affect safety and efficacy in patients undergoing rotational atherectomy during CTO-PCI?
p-value: p=0.054
Rotational atherectomy is feasible in retrograde CTO-PCI with similar in-hospital success rates to anterograde approaches, despite more complex lesions and a trend toward more procedural complications.
Supports rotational atherectomy via retrograde CTO-PCI; leaves open whether complications differ from anterograde.
Coronary chronic total occlusions (CTOs) are characterized by a high incidence of severe plaque calcifications, which are associated with a high use of the retrograde approach and a low success rate of percutaneous coronary intervention (PCI). However, the feasibility of rotational atherectomy (RA) in retrograde CTO-PCI remains unknown. The aim of the present study is to examine the safety and efficacy of RA in retrograde CTO-PCI. Consecutive patients (n = 129) who underwent RA during CTO-PCI were categorized into anterograde and retrograde groups according to the CTO crossing approach. The distributions of the baseline characteristics were similar in the 2 groups, but the lesion type was more complex ( P = .001), and the starting burr size was smaller ( P = .003) in the retrograde group than in the anterograde group. There was a trend of a higher incidence of procedural complications in the retrograde group than in the anterograde group ( P = .054). Technical and procedural success and in-hospital outcomes were not significantly different between the 2 groups. In conclusion, RA was feasible in retrograde CTO PCI, but some specific precautions are required before and during the procedure. In addition, further investigation of the long-term outcomes of RA in retrograde CTO PCI is necessary.
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Xu et al. (2020) conducted a cohort in Coronary chronic total occlusions (CTOs) (n=129). Retrograde approach vs. Anterograde approach was evaluated on Procedural complications (p=0.054). Rotational atherectomy in retrograde CTO-PCI yielded similar technical success to the anterograde approach, with a trend toward higher procedural complications (P=0.054).
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