Retrograde direct stent puncture for femoropopliteal lesion crossing is safe and effective – results from a multicenter German registry

<b></b> <i>Background:</i> To evaluate the safety and efficacy of direct retrograde stent punctures for crossing of chronic total occlusions in patients with symptomatic peripheral arterial disease. <i>Methods:</i> A retrospective registry of consecutive patients treated with retrograde recanalization techniques in five high-volume German centers was performed. Patient cases with attempted retrograde after failed antegrade revascularization were studied. Primary endpoint was technical success. Secondary endpoints were access vessel complications, need for bail-out procedures and major or minor amputation. <i>Results:</i> Of the 1516 retrograde punctures recorded in the registry, 63 (4.2%) were direct stent punctures. Superficial femoral artery stents were punctured in 88.9% (56/63) of the cases, tibial artery stents in 6 patients (9.5%) and a stent in an occluded femoropopliteal bypass in one case (1.6%). Mean lesion length was 322±125 mm. Stent puncture was successful in 62 cases (98.4%) and the procedural success rate was 96.8% (61/63) with one technical failure despite successful puncture. A sheathless approach was performed in 79.4% (50/63) of cases. Drug-coated balloon angioplasty was applied in 63.5% (40/63) and new stenting (bare-metal or drug-eluting) in 55.6% (35/63) of lesions. One minor and no major amputations were recorded in the first 30 days after the procedure. A sheathless retrograde approach was associated with significantly higher procedural technical success (p = .04). <i>Conclusion:</i> Retrograde femoral or tibial direct stent puncture seems to be safe and effective for the recanalization of chronic total occlusions of the femoropopliteal segment in cases where antegrade recanalization is deemed unsuccessful.