TY - JOUR JO - EuroIntervention TI - Retrograde approach for the percutaneous recanalisation of coronary chronic total occlusions: contribution to clinical practice and long-term outcomes AB - <p><strong>Aims:</strong> We aimed to evaluate the contribution of the retrograde approach to real-world practice over time and its long-term outcomes in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).</p> <p><strong>Methods and results:</strong> We evaluated 1,635 CTO procedures conducted at our high-volume centre between 2003 and 2015. The retrograde approach has been actively adopted in practice since January 2007. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularisation/reocclusion. The technical success rate of CTO-PCI has increased from 79.5% to 87.1% since 2007, although the complexity of the CTOs has also significantly increased in that time (J-CTO scores: from 1.8&plusmn;1.2 to 2.0&plusmn;1.1, p=0.03). The incidence of in-hospital MACCE using the retrograde approach was 4.5%, which was comparable to the antegrade-only approach rate of 4.1% (p=0.58). The retrograde approach showed a higher four-year TVF rate after successful stenting compared with the antegrade-only approach (17.1% vs 9.4%, p=0.01), but this difference was mainly driven by a higher target vessel revascularisation/reocclusion rate. Multivariable analysis revealed that renal dysfunction (hazard ratio [HR] 3.33, 95% confidence interval [CI]: 1.42-7.83), acute coronary syndrome (HR 1.99, 95% CI: 1.26-3.14), the J-CTO score (per 1, HR 1.23, 95% CI: 1.00-1.51), and the smallest stent diameter (per 1 mm, HR 0.39, 95% CI: 0.21-0.74) (all p&lt;0.05) were independently associated with TVF.</p> <p><strong>Conclusions:</strong> A retrograde approach contributes to the increased success of more complex CTO-PCI over time with an acceptable frequency of in-hospital complications and four-year TVF rate.</p> AU - Kwon Osung AU - Lee Hyung Pil AU - Lee Seung-Whan AU - Lee Jong-Young AU - Kang Do-Yoon AU - Ahn Jung-Min AU - Park Duk-Woo AU - Kang Soo-Jin AU - Kim Young-Hak AU - Lee Whan Cheol AU - Park Seong-Wook AU - Park Seung-Jung VL - 15 IS - 4 Y1 - 19/07/2019 Y1 - 2019 DOI - 10.4244/EIJ-D-18-00538 SP - e354 EP - e361 KW - chronic coronary total occlusion KW - drug-eluting stent KW - other technique PB - Europa Digital & Publishing SE - Coronary interventions UR - https://eurointervention.pcronline.com/article/retrograde-approach-for-percutaneous-recanalization-of-coronary-chronic-total-occlusions-contribution-to-clinical-practice-and-its-long-term-results SN - 1774-024X ER -