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

Peter Tajti, Aris Karatasakis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, Anthony H. Doing, Catalin Toma, Barry Uretsky, Santiago Garcia, Jeffrey W. Moses, Manish Parikh, Ajay Kirtane, Ziad A. Ali, Raja Hatem, Judit Karacsonyi, Barbara A. DanekBavana V. Rangan, Subhash Banerjee, Imre Ungi, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
JournalJournal of Invasive Cardiology
Issue number3
StatePublished - Mar 2018

Bibliographical note

Funding Information:
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Tajti and Karatasakis report no disclosures. Dr Karmpaliotis reports speaker honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr Alaswad reports consulting fees from Terumo and Boston Scientific; consultancy (non-financial) to Abbott Laboratories. Dr Jaffer reports consulting for Abbott Vascular and Boston Scientific; research grants from Canon, Siemens, National Institutes of Health. Dr Yeh reports a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr Patel reports speakers’ bureau fees from Astra Zeneca. Dr Mahmud reports consulting fees from Medtronic and Corindus; speaker’s fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St. Jude. Drs Choi, Doing, Toma, and Uretsky report no disclosures. Dr Garcia reports consulting fees from Medtronic. Dr Moses reports consultancy to Boston Scientific and Abiomed. Dr Parikh reports speakers’ bureau fees from Abbott Vascular, Medtronic, CSI, BSC, Trireme; advisory boards for Medtronic, Abbott Vascular, and Philips. Dr Kirtane reports institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, Glaxo SmithKline, and Eli Lilly. Dr Ali reports consultant fees/honoraria from St. Jude Medical and AstraZeneca Pharmaceuticals; ownership interest/ partnership/principal in Shockwave Medical and VitaBx, Inc; and research grants from Medtronic and St. Jude Medical. Drs Hatem, Karacsonyi, and Danek report no disclosures. Dr Rangan reports research grants from InfraReDx, Inc and Spec-tranetics. Dr Banerjee reports research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCare Global (spouse); intellectual property in HygeiaTel. Dr Brilakis reports personal fees from Abbott Vascular, Acist, Amgen, Asahi Intecc, CSI, El-sevier, GE Healthcare, Medicure, and Nitiloop; grants from Boston Scientific and Osprey; he serves on the Board of Directors for the Cardiovascular Innovations Foundation and the Board of Trustees of the Society of Cardiovascular Angiography and Interventions.

Funding Information:
Clinical Trial Registration: NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Funding: The Progress CTO registry has received support from the Abbott North-western Hospital Foundation. Research reported in this publication was supported by the Clinical and Translational Science Awards Program of the National Institutes of Health (Bethesda, MD, USA) under grant number UL1-RR024982. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2018 HMP Communications. All rights reserved.


  • LIMA
  • chronic total occlusion
  • left internal mammary artery graft
  • retrograde PCI


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