Antegrade versus retrograde approach for recanalization of ostial or stumpless coronary chronic total occlusion

Abstract

Abstract Background Data on the procedural and in-hospital clinical effects of the antegrade-only and retrograde methods for ostial or stumpless CTO PCI are scarce.The purpose of this research was to assess the procedural and in-hospital clinical results of percutaneous coronary intervention (PCI) for ostial or stumpless chronic total occlusion (CTO) using both the antegrade-only and retrograde approaches.Methods We performed a retrospective analysis of the procedural and in-hospital clinical effect of 89 consecutive patients who received ostial or stumpless CTO PCI at our institution between April 2015 and October 2022.Results The antegrade-olny method had a higher technical success rate(92.0% vs.71.9%,p = 0.041 ) and procedural success rate(92.0% vs.68.8%,p = 0.022 ) compared to the retrograde approach (RA) .The RA group had a substantially greater Japanese-CTO (J-CTO) score than the antegrade only approach group (2.45 ± 0.73 vs. 1.64 ± 0.70, p < 0.001). Lesion length of 20 mm or more was notably more prevalent in the RA group than the antegrade-only group (73.4% vs. 28.0%, p < 0.001). The antegrade-only approach group exhibited a higher incidence of microchannels at the proximal stump compared to the RA group (56.0% vs. 10.9%, p < 0.001). In-hospital major adverse cardiac events (MACE) and in-hospital myocardial infarction (MI) were more frequently observed in the RA cases (18.8% vs. 0, p = 0.003; 15.6% vs. 0, p = 0.008). The J-CTO score of less than 2 and the presence of microchannels at the proximal stump were identified as predictors for successful antegrade-only approach PCI for ostial or stumpless CTO (OR: 2.79 [95% CI: 1.92–5.03, P = 0.003]; OR: 2.89 [95% CI: 1.32–6.03, P = 0.001]).Conclusions Compared to RA PCI for ostial or stumpless CTO, the antegrade only approach is utilized for less complex CTO lesions and omes with a reduced likelihood of in-hospital MACE and complications.