Active Retrograde Extra Backup with a Mother-and-Child Catheter to Facilitate Retrograde Microcatheter Collateral Channel Tracking in Recanalization of Coronary Chronic Total Occlusion.

Yong Wang,Qing-Kun Meng,Yi Li,Cheng-Fu Wang,Bao-Jun Chen,Bo Luan,De-Feng Luo,Yu Zhu,Xiao-Jiao Zhang,Hong-Wei Zhao,Jie Tao,Ai-Jie Hou

doi:10.1155/2020/4245191

Abstract

Objective To explore the feasibility and safety of the active retrograde backup (ARB) for treatment of chronic total occlusion (CTO) during retrograde percutaneous coronary intervention (PCI). Background Guiding support plays an important role in guidewire and microcatheter coronary channel (CC) tracking in retrograde PCI therapy for patients with CTO. However, the feasibility and safety of retrograde active use of a mother-and-child catheter are still unclear. Patients and Methods. A total of 271 consecutive patients with CTO who underwent retrograde PCI between January 2015 and January 2020 were retrospectively analyzed. Clinical data of two groups were compared to evaluate the feasibility and safety of ARB. Results Of the 271 patients, 69.0% (187/271) underwent therapy through the septal branch, 31.0% (84/271) through the epicardial collateral channel, and 47.6% (129/271) through active retrograde extra backup with a mother-and-child catheter to facilitate retrograde microcatheter collateral CC tracking. The time of wire CC tracking was shorter in the ARB group than that in the non-ARB group (25.4 ± 8.5 vs 26.4 ± 9.7, p=0.348), but there was no significant difference. The duration of the retrograde microcatheter tracking (10.2 ± 3.8 vs 15.5 ± 6.8, p=0.012) and the retrograde approach (62.8 ± 20.3 vs 70.4 ± 24.3, p=0.026) in the ARB group was significantly shorter than that in the non-ARB group. The radiation dose (223.6 ± 112.7 vs. 295.2 ± 129.3, p=0.028), fluoroscopy time (50.6 ± 21.3 vs 62.3 ± 32.1, p=0.030), and contrast volume (301.8 ± 146.7 vs 352.2 ± 179.5, p=0.032) in the ARB group were significantly lower than that in the non-ARB group. There were no life-threatening procedural complications in either group. Complications unrelated to ARB included two cases of donor-vessel dissection, one case of CC perforation, and two cases of target-vessel perforation. There was no statistically significant difference in major adverse cardiac and cerebrovascular events between the groups during hospitalization (p > 0.05). Conclusion ARB is feasible, safe, and conducive to guidewire and microcatheter CC tracking in the recanalization of coronary CTO. It improves procedural efficiency and is worthy of further promotion.

Highlights

Chronic total occlusion (CTO) lesions occur in 16–18% of patients with coronary artery disease undergoing coronary angiography [1, 2]
With advances in devices and new techniques, the most important being the introduction of the retrograde approach, the probability of success is above 90% at present
Retrograde interventional therapy for CTO-percutaneous coronary intervention (PCI) still faces great challenges. e primary retrograde approach may be considered as an alternative in patients who failed in antegrade CTO-PCI or those who have good collateral circulation

Summary

Introduction

Chronic total occlusion (CTO) lesions occur in 16–18% of patients with coronary artery disease undergoing coronary angiography [1, 2]. Before the introduction of the retrograde approach, the success rate of revascularization of CTO lesions was approximately 70% [3]. E primary retrograde approach may be considered as an alternative in patients who failed in antegrade CTO-PCI or those who have good collateral circulation. E core of the retrograde interventional therapy is microcatheter tracking after successful guidewire tracking. Even if the guidewire passes through, Journal of Interventional Cardiology retrograde microcatheter coronary channel (CC) tracking remains a challenge. We found that the failure of microcatheter tracking in some patients was related to the poor supporting ability of retrograde guiding, and in cases where the retrograde guidewire has passed through the collateral circulation, replacing guiding is not the first choice. We evaluated the feasibility and safety of Guidezilla (a motherand-child catheter)-based active retrograde extra backup—termed active retrograde backup (ARB)—to facilitate retrograde microcatheter collateral channel tracking in the recanalization of CTO lesions

Materials and Methods

Results

Conclusions