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Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention via Saphenous Vein Graft

2020; Elsevier BV; Volume: 13; Issue: 4 Linguagem: Inglês

10.1016/j.jcin.2019.10.028

1936-8798

Iosif Xenogiannis, Fotis Gkargkoulas, Dimitri Karmpaliotis, Oleg Krestyaninov, Dmitrii Khelimskii, Farouc A. Jaffer, Jaikirshan Khatri, David E. Kandzari, R. Michael Wyman, Anthony Doing, Philip Dattilo, Catalin Toma, Robert W. Yeh, Hector Tamez, James W. Choi, Wissam Jaber, Habib Samady, Abdul Malik Sheikh, Srinivasa Potluri, Mitul Patel, Ehtisham Mahmud, Basem Elbaruni, Michael P. Love, Michalis Koutouzis, Ioannis Tsiafoutis, Brian Jefferson, Taral Patel, Barry F. Uretsky, Jeffrey W. Moses, Nicholas Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Allison B. Hall, Michael Megaly, Evangelia Vemmou, Ilias Nikolakopoulos, Bavana V. Rangan, Pamela Morley, Bassel Bou Dargham, Shuaib Abdullah, Santiago García, Subhash Banerjee, M. Nicholas Burke, Emmanouil S. Brilakis, Khaldoon Alaswad,

Antiplatelet Therapy and Cardiovascular Diseases

The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).The use of SVGs for retrograde crossing during CTO PCI has received limited study.A total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group).Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p < 0.01) and had higher rates of prior myocardial infarction (62% vs. 51%; p < 0.01) and prior PCI (81% vs. 70%; p < 0.01). They were more likely to have moderate or severe calcification (81% vs. 65%; p < 0.01) and moderate or severe tortuosity (53% vs. 44%; p = 0.02) and had similar J-CTO (Multicenter CTO Registry in Japan) scores (3.2 ± 1.0 vs. 3.1 ± 1.1; p = 0.13) but higher PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (4.7 ± 1.7 vs. 3.1 ± 1.1; p < 0.01). Technical (85% vs. 78%; p = 0.04) and procedural (81% vs. 74%; p = 0.04) success rates were higher in the SVG group, with no difference in in-hospital major adverse events (6.4% vs. 4.4%; p = 0.22). Contrast volume was lower in the SVG group (225 ml [173 to 325 ml] vs. 292 ml [202 to 400 ml]; p < 0.01).Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.