Retrograde recanalization of chronic total occlusions in Europe: Procedural, in-hospital, and long-term outcomes from the multicenter ERCTO registry

Alfredo R. Galassi, Georgios Sianos, Gerald S. Werner, Javier Escaned, Salvatore D. Tomasello, Marouane Boukhris, Marine Castaing, Joachim H. Büttner, Alexander Bufe, Artis Kalnins, James C. Spratt, Roberto Garbo, David Hildick-Smith, Simon Elhadad, Andrea Gagnor, Bernward Lauer, Leszek Bryniarski, Evald H. Christiansen, Leif Thuesen, Markus Meyer-GeßnerOmer Goktekin, Mauro Carlino, Yves Louvard, Thierry Lefèvre, Aigars Lismanis, Valery L. Gelev, Antonio Serra, Francesco Marzà, Carlo Di Mario, Nicolaus Reifart

Research output: Contribution to journalArticlepeer-review


Background A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). Objectives The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs. Methods Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. Results The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p <0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p <0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p <0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p <0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. Conclusions The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.

Original languageEnglish
Pages (from-to)2388-2400
Number of pages13
JournalJournal of the American College of Cardiology
Issue number22
Publication statusPublished - Jun 9 2015


  • chronic total occlusions
  • J-CTO score
  • retrograde PCI revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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