Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions

2009 ◽  
Vol 74 (4) ◽  
pp. 555-563 ◽  
Author(s):  
Jen Te Hsu ◽  
Hideo Tamai ◽  
Eisho Kyo ◽  
Takafumi Tsuji ◽  
Satoshi Watanabe
Keyword(s):  
Percutaneous Treatment ◽  
Retrograde Approach ◽  
Chronic Total Occlusions ◽  
Antegrade Approach

scholarly journals Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

Kardiologiia ◽  
2019 ◽  
Vol 59 (2) ◽  
pp. 10-16
Author(s):  
D. A. Khelimskii ◽  
O. V. Krestyaninov ◽  
A. G. Badoyan ◽  
D. N. Ponomarev ◽  
E. A. Pokushalov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Retrograde Approach ◽  
Endovascular Techniques ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
National Medical ◽  
Antegrade Approach ◽  
Percutaneous Coronary

Purpose:to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.Materials and methods.We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014–2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.Results.Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach – in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.Conclusions.The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.

Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions

2007 ◽  
Vol 69 (6) ◽  
pp. 826-832 ◽  
Author(s):  
Jean-François Surmely ◽  
Osamu Katoh ◽  
Etsuo Tsuchikane ◽  
Kenya Nasu ◽  
Takahiko Suzuki
Keyword(s):  
Percutaneous Treatment ◽  
Retrograde Approach ◽  
Chronic Total Occlusions

Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2019 ◽  
Vol 26 (3) ◽  
pp. 342-349 ◽  
Author(s):  
Damianos G. Kokkinidis ◽  
T. Raymond Foley ◽  
Ryan Cotter ◽  
Prio Hossain ◽  
Bejan Alvandi ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Regression Models ◽  
Target Lesion ◽  
Retrograde Approach ◽  
Initial Attempt ◽  
Iliac Arteries ◽  
Chronic Total Occlusions ◽  
Logistic Regression Models ◽  
Antegrade Approach ◽  
Procedural Complications

Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6% of initial antegrade attempts and 9.6% of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4%) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1% vs 93.2%, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2% vs 9.2%, p<0.001) and with balloon-expandable stents (39.2% vs 17.7%, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95% CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.

scholarly journals Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

2020 ◽  
Vol 29 (03) ◽  
pp. 143-148
Author(s):  
Ranjit Kumar Nath ◽  
Siva Subramaniyan ◽  
Neeraj Pandit ◽  
Deepankar Vatsa
Keyword(s):  
High Risk ◽  
Peripheral Arterial Disease ◽  
Femoral Artery ◽  
Lower Limb ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Retrograde Approach ◽  
Femoral Access ◽  
Antegrade Approach ◽  
Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

Outcomes of retrograde approach for chronic total occlusions by guidewire location

2021 ◽  
Vol 17 (8) ◽  
pp. e647-e655
Author(s):  
Yongzhen Fan ◽  
Akiko Maehara ◽  
Myong Hwa Yamamoto ◽  
Emad U. Hakemi ◽  
Khady N. Fall ◽  
...  
Keyword(s):  
Retrograde Approach ◽  
Chronic Total Occlusions

scholarly journals Mechanical thrombectomy in acute ischemic stroke with tandem occlusions: impact of extracranial carotid lesion etiology on endovascular management and outcome

2021 ◽  
Vol 51 (1) ◽  
pp. E6
Author(s):  
Valerio Da Ros ◽  
Jacopo Scaggiante ◽  
Francesca Pitocchi ◽  
Fabrizio Sallustio ◽  
Simona Lattanzi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Demographic Data ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Endovascular Management ◽  
Retrograde Approach ◽  
Antegrade Approach ◽  
Tandem Occlusion

OBJECTIVE Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO. METHODS A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M1 middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology. RESULTS In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4–0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology. CONCLUSIONS ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CA-related TOs.

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