Outcomes with retrograde versus antegrade chronic total occlusion revascularization

Michael Megaly, Abdelrahman Ali, Marwan Saad, Mohamed Omer, Iosif Xenogiannis, Gerald S. Werner, Dimitri Karmpaliotis, Juan J. Russo, Masahisa Yamane, Roberto Garbo, Andrea Gagnor, Imre Ungi, Stephane Rinfret, Ashish Pershad, Jaroslaw Wojcik, Santiago Garcia, Kambis Mashayekhi, Georgios Sianos, Alfredo R. Galassi, M. Nicholas BurkeEmmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Objectives: The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. Methods: We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. Results: Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p <.001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p <.001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p <.001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41–4.51, p =.002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47–3.08; p <.001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84–3.81, p =.13), but a higher incidence of MI (OR 2.07, 95% CI 1.1–3.88, p =.02), target vessel revascularization (OR 1.92, 95% CI 1.49–2.46, p <.001), and target lesion revascularization (OR 2.08, 95% CI 1.33–3.28, p =.001). Conclusions: Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.

Original languageEnglish (US)
Pages (from-to)1037-1043
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Issue number5
StatePublished - Nov 1 2020
Externally publishedYes


  • antegrade
  • chronic total occlusion
  • outcomes
  • percutaneous coronary intervention
  • retrograde

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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