Retrograde Approach of CTO PCI

  • Jon Suh
  • Nae Hee LeeEmail author


The success rate of the percutaneous coronary intervention for coronary chronic total occlusion (CTO-PCI) was 65–70% when using only the antegrade approach, so it was difficult to expect a high success rate. However, the introduction of the retrograde approach using the native collateral channel has significantly increased the success rate of the procedure. In the early days of the retrograde approach, the complexity and variability of the procedure and the possibility of complications caused practitioners to hesitate to use this method, but thanks to the development of techniques and tools, a recent report suggests that the retrograde approach is used for approximately 30% of all CTO-PCIs [1].


  1. 1.
    Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Park SJ, de Winter R. Changing strategies of the retrograde approach for chronic total occlusion during past the 7 years. Catheter Cardiovasc Interv. 2013;81(4):E178–85.CrossRefGoogle Scholar
  2. 2.
    Lee NH, Seo HS, Choi JH, Suh J, Cho YH. Recanalization strategy of retrograde angioplasty in patients with coronary chronic total occlusion -analysis of 24 cases, focusing on technical aspects and complications. Int J Cardiol. 2010;144(2):219–29.CrossRefGoogle Scholar
  3. 3.
    Saito S. Different strategies of retrograde approach in coronary angioplasty for chronic total occlusion. Catheter Cardiovasc Interv. 2008;71:8–19.CrossRefGoogle Scholar
  4. 4.
    Rathore S, Katoh O, Matsuo H, Terashima M, Tanaka N, Kinoshita Y, Kimura M, Tsuchikane E, Nasu K, Ehara M, Asakura K, Asakura Y, Suzuki T. Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: procedural outcomes and predictors of success in contemporary practice. Circ Cardiovasc Interv. 2009;2(2):124–32.CrossRefGoogle Scholar
  5. 5.
    Ge L, Qian JY, Liu XB, Qin Q, Cui SJ, Yao K, et al. Retrograde approach for the recanalization of coronary chronic total occlusion: preliminary experience of a single center. Chin Med J (Engl). 2010;123(7):857–63.Google Scholar
  6. 6.
    Suh J, Cho YH, Lee NH. Antegrade ballooning with retrograde approach for the treatment of long restenotic total occlusion. J Invasive Cardiol. 2011;23(7):E164–7.PubMedGoogle Scholar
  7. 7.
    Brilakis ES, Grantham JA, Thompson CA, DeMartini TJ, Prasad A, Sandhu GS, Banerjee S, Lombardi WL. The retrograde approach to coronary artery chronic total occlusions: a practical approach. Catheter Cardiovasc Interv. 2012;79(1):3–19.CrossRefGoogle Scholar
  8. 8.
    Lee NH, Suh J, Cho YH, et al. Recanalization of a coronary chronic total occlusion by a retrograde approach using ipsilateral double guiding-catheters. Korean Circ J. 2009;39:42–5.CrossRefGoogle Scholar
  9. 9.
    Surmely JF, Katoh O, Tsuchikane E, Nasu K, Suzuki T. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2007;69:826–32.CrossRefGoogle Scholar
  10. 10.
    Tsuchikane E, Katoh O, Kimura M, Nasu K, Kinoshita Y, Suzuki T. The first clinical experience with a novel catheter for collateral channel tracking in retrograde approach for chronic coronary total occlusions. JACC Cardiovasc Interv. 2010;3(2):165–71.CrossRefGoogle Scholar
  11. 11.
    Surmely JF, Tsuchikane E, Katoh O, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol. 2006;18:334–8.PubMedGoogle Scholar
  12. 12.
    Rathore S, Katoh O, Tuschikane E, Oida A, Suzuki T, Takase S. A novel modification of the retrograde approach for the recanalization of chronic total occlusion of the coronary arteries intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking. JACC Cardiovasc Interv. 2010;3(2):155–64.CrossRefGoogle Scholar
  13. 13.
    Lee NH, Suh J, Seo HS. Double anchoring balloon technique for recanalization of coronary chronic total occlusion by retrograde approach. Catheter Cardiovasc Interv. 2009;73:791–4.CrossRefGoogle Scholar
  14. 14.
    Suh J, Cho YH, Lee NH. Bail-out reverse controlled antegrade and retrograde subintimal tracking accompanied by multiple complications in coronary chronic total occlusion. J Invasive Cardiol. 2008;20:E334–7.PubMedGoogle Scholar
  15. 15.
    Chai W-l, Agyekum F, Zhang B, Liao H-T, Ma D-L, Zhong Z-A, Wang P-N, Jin L-J. Clinical prediction score for successful retrograde procedure in chronic total occlusion percutaneous coronary intervention. Cardiology. 2016;134:331–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Soon Chun Hyang University, Bucheon HospitalBucheonSouth Korea

Personalised recommendations