Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry.

A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs. Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.

Galassi AR ，Sianos G ，Werner GS ，Escaned J ，Tomasello SD ，Boukhris M ，Castaing M ，Büttner JH ，Bufe A ，Kalnins A ，Spratt JC ，Garbo R ，Hildick-Smith D ，Elhadad S ，Gagnor A ，Lauer B ，Bryniarski L ，Christiansen EH ，Thuesen L ，Meyer-Geßner M ，Goktekin O ，Carlino M ，Louvard Y ，Lefèvre T ，Lismanis A ，Gelev VL ，Serra A ，Marzà F ，Di Mario C ，Reifart N ，Euro CTO Club ... -  《-》

In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry.

Galassi AR ，Tomasello SD ，Reifart N ，Werner GS ，Sianos G ，Bonnier H ，Sievert H ，Ehladad S ，Bufe A ，Shofer J ，Gershlick A ，Hildick-Smith D ，Escaned J ，Erglis A ，Sheiban I ，Thuesen L ，Serra A ，Christiansen E ，Buettner A ，Costanzo L ，Barrano G ，Di Mario C ... -  《-》

Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions.

To study the long-term outcomes of rotational atherectomy (RA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). There is little evidence on the incidence, procedural results and long-term outcomes of RA for CTO PCI. This registry included data from consecutive patients undergoing CTO PCI at four specialized centers. Major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction and ischemia-driven target-vessel revascularization) on follow-up were the primary endpoint. A total of 1003 patients were included. Of these, 35 (3.5%) required RA. As compared with Conventional PCI, RA patients were older (68.9 ± 9.5 vs. 64.6 ± 10.7 years, P = 0.02), had higher prevalence of diabetes (58% vs. 37%, P = 0.01) and of a J-CTO score ≥2 (80% vs. 58%, P = 0.009), driven by severe calcification. Antegrade wire escalation was used more frequently in RA (74% vs. 53%, P = 0.08). RA was performed for balloon failure-to-cross in 51% and failure-to-expand in 49%. One burr was utilized in 86%. The 1.25-mm burr was the largest burr used in 43%. Slow flow/no-reflow was observed in 17%. No other serious RA-related complications were observed. Procedural success was 77% vs. 89% (P = 0.04) in RA vs. Conventional PCI. After a mean follow-up of 658 ± 412 days, MACE rates were similar between groups (15% vs. 13%, P = 0.70). The use of RA in CTO PCI was safe, despite a worse patient risk profile and higher procedural complexity, as compared with conventional techniques. Although procedural success was lower in the RA group, there were no differences in long-term clinical outcomes between groups. © 2016 Wiley Periodicals, Inc.

Azzalini L ，Dautov R ，Ojeda S ，Serra A ，Benincasa S ，Bellini B ，Giannini F ，Chavarría J ，Gheorghe LL ，Pan M ，Carlino M ，Colombo A ，Rinfret S ... -  《-》

In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure.

The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.

Tajti P ，Alaswad K ，Karmpaliotis D ，Jaffer FA ，Yeh RW ，Patel M ，Mahmud E ，Choi JW ，Burke MN ，Doing AH ，Toma C ，Uretsky B ，Holper E ，Wyman RM ，Kandzari DE ，Garcia S ，Krestyaninov O ，Khelimskii D ，Koutouzis M ，Tsiafoutis I ，Jaber W ，Samady H ，Moses JW ，Lembo NJ ，Parikh M ，Kirtane AJ ，Ali ZA ，Doshi D ，Xenogiannis I ，Rangan BV ，Ungi I ，Banerjee S ，Brilakis ES ... -  《-》

Use of Saphenous Vein Bypass Grafts for Retrograde Recanalization of Coronary Chronic Total Occlusions: Insights From a Multicenter Registry.

Nguyen-Trong PK ，Alaswad K ，Karmpaliotis D ，Lombardi W ，Grantham JA ，Lembo N ，Kandzari D ，Karatasakis A ，Karacsonyi J ，Danek BA ，Rangan BV ，Roesle M ，Ayers CR ，Thompson CA ，Banerjee S ，Brilakis ES ... -  《-》