Despite the fact that the incidence of chronic total occlusions (CTO) in patients with angiographically significant coronary artery disease (CAD) is usually above 30%, they account for just 10–15% of all percutaneous coronary interventions (PCI).1,2 Successful recanalization of CTO of the coronary arteries has been associated with improved survival, improved left ventricular systolic function, reduced angina, and increased exercise capacity.3–5 Despite these results, there is still no consensus on clinical indication for their treatment.4,5 When compared with nonocclusive coronary artery disease, CTO represents certainly the greatest anatomical and technical challenge with higher incidence of procedural complications and increased restenosis rates.6,7 Procedural success rate for CTO has improved over time from 50–60% up to 75–90% for experienced operators mainly due to increased use of the retrograde approach which was created and developed by the Japanese operators.8 In 1990, the first report of retrograde approach for CTOwas published, in which the retrograde wire crossing technique was applied via a degenerated saphenous vein graft (SVG).9 Different kinds of retrograde techniques were introduced in the past 5 years, such as kissing wire technique, knuckle wire technique, the controlled 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 The purpose of this report was to describe our experience with initiation of retrograde PCI for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up.

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

GALASSI, ALFREDO;
2012-01-01

Abstract

Despite the fact that the incidence of chronic total occlusions (CTO) in patients with angiographically significant coronary artery disease (CAD) is usually above 30%, they account for just 10–15% of all percutaneous coronary interventions (PCI).1,2 Successful recanalization of CTO of the coronary arteries has been associated with improved survival, improved left ventricular systolic function, reduced angina, and increased exercise capacity.3–5 Despite these results, there is still no consensus on clinical indication for their treatment.4,5 When compared with nonocclusive coronary artery disease, CTO represents certainly the greatest anatomical and technical challenge with higher incidence of procedural complications and increased restenosis rates.6,7 Procedural success rate for CTO has improved over time from 50–60% up to 75–90% for experienced operators mainly due to increased use of the retrograde approach which was created and developed by the Japanese operators.8 In 1990, the first report of retrograde approach for CTOwas published, in which the retrograde wire crossing technique was applied via a degenerated saphenous vein graft (SVG).9 Different kinds of retrograde techniques were introduced in the past 5 years, such as kissing wire technique, knuckle wire technique, the controlled 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 The purpose of this report was to describe our experience with initiation of retrograde PCI for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/47729
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