Efficacy of Primary Retrograde Approach in Complex Chronic Total Occlusions With Unfavorable Antegrade Characteristics and Feasible Interventional Collaterals
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. METHODS AND RESULTS: This single-center retrospective cohort study included all patients undergoing coronary CTO-PCI attempted by experienced high-volume operators between January 2016 and July 2023. The difficulty of the antegrade approach was determined using the Japanese CTO score, and the feasibility of interventional collaterals was determined using the collateral channel score. In 698 patients undergoing CTO-PCI, the overall technical and initial guidewire success rates were 91.4% and 83.8%, respectively. Of 380 patients with a Japanese CTO score ≥3 and a collateral channel score ≥2, PAA and PRA were performed in 161 (42.4%) and 219 (57.6%) patients, respectively. Initial guidewire success was higher with PRA than PAA (88.1% vs. 78.9%; P=0.01), and bail-out success was higher for a retrograde than antegrade approach (91.2% vs. 56%; P=0.0019). PRA was associated with longer guidewire crossing time, longer fluoroscopy time, and greater contrast use. CONCLUSIONS: In patients with challenging CTO, poor antegrade conditions, and feasible interventional collaterals, PRA achieved higher initial guidewire success at the expense of higher procedural burden/resource use.
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BibTeX
@article{qayed2026efficacy,
title = {{Efficacy of Primary Retrograde Approach in Complex Chronic Total Occlusions With Unfavorable Antegrade Characteristics and Feasible Interventional Collaterals}},
author = {Khaled Saber Qayed and Cheng-Wei Lien and Jui Wang and Hsien-Li Kao and Chih-Fan Yeh and Ying-Hsien Chen and Mao-Shin Lin and Salwa Roshdy Demitry and Mohamed Abdel Ghany and Salma Taha and Ching-Chang Huang},
journal = {Circulation Journal},
year = {2026},
month = jul,
doi = {10.1253/circj.cj-25-1019},
url = {https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-25-1019/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Efficacy of Primary Retrograde Approach in Complex Chronic Total Occlusions With Unfavorable Antegrade Characteristics and Feasible Interventional Collaterals
AU - Khaled Saber Qayed
AU - Cheng-Wei Lien
AU - Jui Wang
AU - Hsien-Li Kao
AU - Chih-Fan Yeh
AU - Ying-Hsien Chen
AU - Mao-Shin Lin
AU - Salwa Roshdy Demitry
AU - Mohamed Abdel Ghany
AU - Salma Taha
AU - Ching-Chang Huang
PY - 2026
DA - 2026/07/24
JO - Circulation Journal
DO - 10.1253/circj.cj-25-1019
UR - https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-25-1019/_article
AB - 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. METHODS AND RESULTS: This single-center retrospective cohort study included all patients undergoing coronary CTO-PCI attempted by experienced high-volume operators between January 2016 and July 2023. The difficulty of the antegrade approach was determined using the Japanese CTO score, and the feasibility of interventional collaterals was determined using the collateral channel score. In 698 patients undergoing CTO-PCI, the overall technical and initial guidewire success rates were 91.4% and 83.8%, respectively. Of 380 patients with a Japanese CTO score ≥3 and a collateral channel score ≥2, PAA and PRA were performed in 161 (42.4%) and 219 (57.6%) patients, respectively. Initial guidewire success was higher with PRA than PAA (88.1% vs. 78.9%; P=0.01), and bail-out success was higher for a retrograde than antegrade approach (91.2% vs. 56%; P=0.0019). PRA was associated with longer guidewire crossing time, longer fluoroscopy time, and greater contrast use. CONCLUSIONS: In patients with challenging CTO, poor antegrade conditions, and feasible interventional collaterals, PRA achieved higher initial guidewire success at the expense of higher procedural burden/resource use.
SN - 1347-4820
SN - 1346-9843
ER -