Efficacy, Safety, and Long-Term Follow-up of Retrograde Approach for CTO Recanalization: Initial (Belgrade) Experience with International Proctorship

Despite the fact that the incidence of chronic totalocclusions (CTO) in patients with angiographicallysignificant coronary artery disease (CAD) is usuallyabove 30%, they account for just 10–15% of all percutaneouscoronary interventions (PCI).1,2 Successfulrecanalization of CTO of the coronary arterieshas been associated with improved survival, improved left ventricular systolic function, reduced angina, andincreased exercise capacity.3–5 Despite these results,there is still no consensus on clinical indication for theirtreatment.4,5 When compared with nonocclusive coronaryartery disease, CTO represents certainly the greatestanatomical and technical challenge with higherincidence of procedural complications and increasedrestenosis rates.6,7 Procedural success rate for CTOhas improved over time from 50–60% up to 75–90%for experienced operators mainly due to increased useof the retrograde approach which was created and developedby the Japanese operators.8In 1990, the first report of retrograde approach forCTOwas published, in which the retrograde wire crossingtechnique was applied via a degenerated saphenousvein graft (SVG).9 Different kinds of retrograde techniqueswere introduced in the past 5 years, such askissing wire technique, knuckle wire technique, thecontrolled antegrade and retrograde subintimal tracking(CART) technique, the reverse CART technique,modified reverse CART technique, wire trapped technique,and reverse wire trapped technique.10–15 Thepurpose of this report was to describe our experiencewith initiation of retrograde PCI for CTO program,focusing on its safety and feasibility, and long-termclinical follow-up.