Ο ρόλος των παλίνδρομων τεχνικών στην σύγχρονη αντιμετώπιση χρόνιων ολικών αποφράξεων των στεφανιαίων αγγείων ; The role of retrograde techniques in contemporary treatment of coronary chronic total occlusions

Background: The study focuses on contemporary retrograde techniques for Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI) and examines the evolution of practice, procedural outcomes and in-hospital complications of CTO PCI in a Northern Greek center of reference.Methods and Results: Data from 680 CTO PCI procedures performed between January 2010 and December 2017 were assessed. The mean patient age was 62.2±10.7 years; 88.2% were men. Technical success increased from 87.2% to 91.7% through the study period (p for trend: 0.515). Patients enrolled over the years had increasing comorbidities and lesion complexity; J-CTO (multicenter CTO registry in Japan) score increased from 2.23±0.76 in 2010-2011 to 2.92±0.057 in 2016-2017, p for trend<0.001). Retrograde approach utilization steadily increased from 35.4% in 2010-2011 to 43.3% in 2016-2017 (p for trend 0.141). Retrograde procedural success was 87%, AWE (Antegrade Wire Escalation) 92.5%, ADR (Antegrade Dissection Reentry) 89.2% (p: 0.081). J-CTO score was significantly higher to patients treated with retrograde techniques (2.93±0.57, p<0.001). In hospital mortality over the study period was 0.1%. In-hospital complication rates remained essentially unchanged through the study period, in the range of 10.9-12.1% (p for trend 0.820), and were higher in retrograde approach (15.7% vs 8.4% in AWE and 12.2% in ADR, p: 0.021). MACE (Major Adverse Cardiac Events) rate was 2.6% and was not associated with the recanalization technique (3.8% in retrograde vs 1.4% in AWE and 4.1% in ADR, p: 0.142).Conclusion: Retrograde approach for CTO PCI increased through the study period and was associated with high technical success rate, despite the increasing complexity of the lesions attempted. The J-CTO score was high for the entire registry and had no predictive value for procedural success. MACE rates for the entire registry was low. In-hospital complication rates were higher for the retrograde approach ; Σκοπός: Η μελέτη έχει αντικείμενο τις σύγχρονες ...