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Efficiency, Safety, and Long-Term Follow-up of Retrograde Approach for CTO Recanalization: Initial (Belgrade) Experience with International Proctorship


  • The institution at which work was performed: Clinic for Cardiology, Clinical Center of Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.

  • Conflict of interest: None to declare.

Sinisa Stojkovic, M.D., Ph.D., Clinic for Cardiology, Clinical Center of Serbia, Medical Faculty, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia. Fax: +381113629056; e-mail:


Background: Retrograde approach increases the success rate for percutaneous recanalization of complex chronic total occlusion (CTO) of coronary arteries.

Objectives: The purpose of this study was to describe our initial experience of retrograde percutaneous coronary intervention for CTO program, focusing on its safety and feasibility, and long-term clinical follow-up.

Methods: The study was a single center retrospective registry which included a total of 40 patients, of 590 CTO treated patients (6.7%), between January 2008 and October 2011, who underwent retrograde approach for CTO recanalization.

Results: Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5% (35/40). Septal collaterals were used to access the occlusion in all cases (100%). Retrograde guidewire crossing of collateral channels was successful in 36/40 (90.0%) patients with success rate of CTO recanalization in these patients of 97.2%. Retrograde approach as the primary strategy was applied in 23/40 (57.5%) patients, retrograde approach immediately after antegrade failure attempt was performed in 8/40 (20.0%) patients, and retrograde approach as elective procedure, after previously failed antegrade attempt, was performed in 9/40 (22.5%) patients. The success rate of these strategies was: 87.0% (20/23 patients) for primary, 87.5% (7/8 patients) for retrograde immediately after antegrade failure, and 88.9% (8/9 patients) for retrograde after previous failed antegrade attempt, respectively. Total in-hospital major adverse cardiac events (MACE) rate was 5.0% (2 non-Q-wave myocardial infarctions). The MACE free survival at median follow-up of 20 months was 89% (95% CI: 78–100%).

Conclusions: This study has demonstrated that adequate training and international proctorship for this complex and demanding technique is a necessity and prerequisite to achieve high overall success rates, with acceptable complication rates and excellent long-term survival rate. (J Interven Cardiol 2012;25:540–548).