Analysis of failures of retrograde percutaneous coronary intervention of chronic total occlusion: from the Japanese Multicenter registry by Retrograde Summit

Background: The Japanese Retrograde Summit was established to analyze the latest results of retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Total 1,166 of retrograde procedure data have been collected between 2009 and 2011. Retrograde procedure success rate has not been dramatically improved throughout these 3 years. Methods: For the purpose of investigating the reason of procedural failure, we analyzed total 328 cases which failed retrograde procedure based on procedural characteristics, and also analyzed the lesion and collateral channel characteristics of our registry failure cases in 2011. Results: Among 328 failed retrograde, the most common failure mode was due to failed collateral channel crossing by guidewire or catheter (72.6%), followed by CTO crossing (22.3%). For deeper analysis of retrograde failure cases, we tried to investigate angiograms of retrograde failure cases and collected 91 of 97 cases (93.8%) from the latest 2011 registry data. Among 91 cases, the reasons of retrograde failure were unsuccessful crossing of collateral channel (57) or CTO (28) and discontinuation due to complication (5). The table describes the features of collateral channel and CTO site of failure cases and occurrence of guidewire perforation for each. View this table: Conclusion: Anatomical complexity was cause of retrograde procedure failure and guidewire perforation. Even after successful collateral channel crossing, CTO crossing was another issue especially in lesion with severe calcification and acute bending. Further improvement of both guidewire and catheter technologies are required to obtain higher procedure success in this clinical setting.