More Complications with Retrograde vs. Antegrade-Only CTO-PCI. ACC. 16
Using the retrograde approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher major adverse cardiovascular event (MACE) rates compared with an antegrade-only approach, according to study results presented at the American College of Cardiology 2016 Scientific Sessions.
“The retrograde approach is integral to the hybrid algorithm for CTO PCI,” said abstract presenter Aris Karatasakis, MD, of the University of Texas Southwestern and VA North Texas Healthcare System in Dallas. “It is essential for achieving high success rates; however, it must be used judiciously due to higher potential for complications.”
The retrograde approach is commonly used in CTO-PCI procedures, especially with more challenging lesions and patients, according to Dr. Karatasakis. To evaluate the safety and efficacy of the retrograde approach, Dr. Karatasakis and colleagues compared the outcomes of the retrograde vs. antegrade-only approach in 1,301 CTO-PCI procedures performed at 11 U.S. centers between 2012 and 2015. The researchers found that the retrograde cases were significantly more complex, including higher prevalence of prior coronary artery bypass graft surgery and higher Japanese Chronic Total Occlusion scores. They had lower technical success and higher MACE rates than the antegrade-only cases. Retrograde cases also required more time, contrast and radiation exposure.
The retrograde approach was used in less than half of the studied cases, either as the initial strategy or after a failed antegrade attempt.
“An important take-away from this study is that the antegrade-only procedures had an exceptionally high success rate and, remarkably, the MACE rate was four-fold higher for the retrograde cases.”
The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.
Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at www.protectedpci.com/hcp/information/isi.