Retrograde CTO-PCI of Native Coronary Arteries Via Left Internal Mammary Artery Grafts: Insights From a Multicenter U.S. Registry

J Invasive Cardiol. 2018 Mar;30(3):89-96. Epub 2017 Nov 15.


Background: Retrograde percutaneous coronary intervention (PCI) of native coronary artery chronic total occlusion (CTO) via left internal mammary artery (LIMA) graft has received limited study.

Methods and results: We compared the clinical and procedural characteristics and outcomes of retrograde CTO-PCI through LIMA grafts vs other conduits in a contemporary multicenter CTO registry. The LIMA was used as the collateral channel in 20 of 990 retrograde CTO-PCIs (2.02%) performed at 18 United States centers. The mean age of the study patients was 69 ± 7 years and 95% were men. The most common CTO target vessel was the right coronary artery (55%). The mean J-CTO score in the LIMA group was high (3.45 ± 0.76). The technical success rates were 70% for retrograde PCI via LIMA graft vs 81.05% for retrograde via other conduits (P=.25), while procedural success rates were 70% for retrograde PCI via LIMA graft and 78.19% for retrograde via other conduits (P=.41). The incidence of major in-hospital complications was also similar between the LIMA and non-LIMA retrograde groups (5% vs 6%; P>.99). Use of guide-catheter extensions (40% vs 28%; P=.22), intravascular ultrasound (45% vs 31%; P=.20), and left ventricular assist devices (24% vs 10%; P=.08) was numerically higher in retrograde CTO-PCIs via LIMA grafts.

Conclusions: Retrograde CTO-PCI is infrequently performed via LIMA grafts and is associated with similar success and major in-hospital complication rates as retrograde CTO-PCI performed via other conduits.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Chronic Disease
  • Coronary Angiography / methods
  • Coronary Occlusion / diagnosis
  • Coronary Occlusion / epidemiology
  • Coronary Occlusion / physiopathology
  • Coronary Occlusion / surgery
  • Coronary Vessels / surgery*
  • Female
  • Humans
  • Male
  • Mammary Arteries / surgery*
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Registries / statistics & numerical data
  • Severity of Illness Index
  • United States / epidemiology