Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions.
Catheter Cardiovasc Interv
; 74(4): 555-63, 2009 Oct 01.
Article
em En
| MEDLINE
| ID: mdl-19360876
ABSTRACT
OBJECTIVES:
The goal of this study was to compare the antegrade-approach and bilateral-approach strategies for chronic total occlusion (CTO).BACKGROUND:
The retrograde approach has been reported for difficult CTO lesions.METHODS:
This study assessed 96 consecutive patients with 119 CTO lesions. The lesions were treated with either an antegrade approach (A group) or a combined bilateral antegrade and retrograde approach (B group). The specific intervention techniques, in-hospital success rate, and major adverse cardiac and cerebrovascular events (MACCE) were compared.RESULTS:
Lesions with well-developed septal collaterals with nontortuous microchannels were preferentially chosen for the B group versus A group (P < 0.001 and 0.008, respectively). Compared with the A group, there were more CTO lesions located in the right coronary artery in the B group (P < 0.001). In the B group, the CTO lesions had a longer length and needed stiffer wires for crossing than in the A group (P = 0.001 and 0.046, respectively). The technical success rate was 94% and 86% for the A group and the B group, respectively (P = 0.127). In-hospital complications were not different between the two groups. The B group needed a higher radiation exposure dose and a greater exposure time than the A group (P < 0.001). In the B group, use of the retrograde method significantly increased the final success rate.CONCLUSIONS:
These results suggest that all CTO lesions should first be managed with an antegrade approach. When there is difficulty crossing the lesion, switching to a bilateral approach is an option for lesions with well-developed collaterals.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Angioplastia Coronária com Balão
/
Oclusão Coronária
Tipo de estudo:
Etiology_studies
/
Observational_studies
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Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article