Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion

Huang, Ching–Chang; Lee, Chih‐Kuo; Meng, Shih-Wei; Hung, Chi‐Sheng; Chen, Ming-Fong; Lin, Mao‐Shin; Yeh, Chih‐Fan; Kao, Hsien‐Li

doi:10.1161/circinterventions.117.005124

Cited by 39 publications

(32 citation statements)

References 28 publications

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“… 7 Previous studies showed that vessel size, severe collateral tortuosity, side branch at CC tortuosity, inadequate CC exit, and Werner CC score were predictors of retrograde wire CC tracking failure. 11 – 13 In some cases, even if the guidewire passes through, retrograde microcatheter coronary channel tracking remains a challenge. To the best of our knowledge, data on this issue are limited.…”

Section: Discussionmentioning

confidence: 99%

<p>Incidence, Predictors, and Strategies for Failure of Retrograde Microcatheter Tracking After Successful Wiring of Septal Collateral Channels in Chronic Total Occlusions</p>

Wang¹,

Zhang²,

Zhao³

et al. 2020

CIA

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Background: Retrograde microcatheter collateral channel (CC) tracking after successful wiring of septal CC is crucial for retrograde revascularization of coronary chronic total occlusion (CTO). However, the incidence, predictors, and strategies for failure of retrograde microcatheter CC tracking after successful wiring of septal CC remain unclear. Methods: In total, 298 patients with CTO who underwent retrograde septal CC PCI between January 2015 and May 2019 were retrospectively analyzed. Clinical data were compared to investigate the predictors of initial microcatheter tracking failure. Results: The initial and final microcatheter tracking success rates were 79.2% (236/298) and 96.6% (288/298), respectively. The procedural success rate was 94.0% (280/298). The right coronary artery-to-left anterior descending artery septal ratio (48.4% vs 33.1%, p=0.037) and CC tortuosity (34.6% vs 20.8%, p=0.045) were significantly higher in the initial microcatheter CC tracking failure group than in the successful tracking group. Multivariate logistic regression analysis revealed that severe collateral tortuosity (odds ratio [OR]: 13.241, 95% confidence interval [CI]: 3.429-27.057, p=0.038), CC entry angle of <90° (OR:4.921, 95% CI: 1.128-9.997, p=0.002), CC exit angle of <90° (OR:5.037, 95% CI: 2.237-11.182, p=0.004), use of Finecross MG as initial microcatheter (OR:1.826, 95% CI: 1.127-3.067, p=0.035), and shunning initial retrograde application of Guidezilla (OR:0.321, 95% CI: 0.267-0.915, p=0.024) were variables independently associated with initial microcatheter CC tracking failure in patients with CTO undergoing retrograde septal CC PCI. Conclusion: The overall initial microcatheter CC tracking failure was 20.8%. Severecollateral tortuosity, CC entry, and exit angle of <90°, use of Finecross MG as initial microcatheter, and shunning initial retrograde application of Guidezilla were variables independently associated with initial microcatheter CC tracking failure in patients with CTO undergoing retrograde septal PCI.

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Section: Discussionmentioning

confidence: 99%

<p>Incidence, Predictors, and Strategies for Failure of Retrograde Microcatheter Tracking After Successful Wiring of Septal Collateral Channels in Chronic Total Occlusions</p>

Wang¹,

Zhang²,

Zhao³

et al. 2020

CIA

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“…Dautov et al found that invisible SC were crossed with as much success as larger CCs and faster [23]. A previous study enrolled 216 patients with retrograde CTO in whom PCI was attempted and revealed collateral channel size as a predictor of failure [9]. We found that small size was an independent factor related to failure of GW crossing in SC.…”

Section: Discussionmentioning

confidence: 50%

“…J-channel score includes the vessel size, reverse bend, continuous bends, and corkscrew; it was developed by Nagamatsu et al in 2020 [8]. HLK score consists of vessel size and tortuosity and was developed by Hsien-Li et al [9]. Successful GW crossing was de ned as the guide wire crossing through the SC from the retrograde side and reaching the distal vessel segment.…”

Section: De Nitionsmentioning

confidence: 99%

“…However, those score systems predicted the success rate of GW crossing through both epicardial and septal collaterals, which lacks the representative for septal approach. Furthermore, the predictors were assigned 1-2 points using logistic regression, which carries low sensitivity and speci city for each patient [6][7][8][9]. Currently, nomogram is considered a useful tool to evaluate the risk by integrating important clinical and anatomical characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Nomogram to Predict Successful Septal Collateral Crossing during Percutaneous Coronary Intervention of Chronic Total Occlusion by retrograde approach: The Sep-CTO score

Liu¹,

Zhan²,

Wu³

et al. 2021

Preprint

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Septal collaterals are the main collaterals used in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, there is little evidence regarding the selection of an interventional septal collateral (SC). we aimed to identify the predictors of successful guidewire crossing using clinical and anatomical characteristics. Overall, 216 derivation cases and 86 validation cases that included retrograde CTO PCI were analyzed. The technical success rate was 79.1% and there were no significant differences in the Gensini score, SYNTAX score, J-CTO score and Progress Score between two groups. Multivariate logistic regression analysis revealed that diabetes, small size, corkscrew, and side branch at tortuosity were independent factors of success in crossing SCs. We developed a nomogram to predict the success rate, which demonstrates favorable calibration and formed the Sep-CTO score. The calibration and decision curve analysis also demonstrated the reliability and accuracy of this clinical prediction model. The receiver-operating characteristic area of the nomogram was 0.870. Compared to the aforementioned scoring systems, Sep-CTO score was the most powerful. The nomogram may be a useful clinical tool. We found four independent variables to predict the successful guidewire crossing in septal collaterals.

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“…The retrograde approach can be performed via bypass grafts, septal, and epicardial CCs. Every CC 19 should be assessed for size (which is usually evaluated using the Werner classification); 20 tortuosity; angles of entry to and exit; bifurcations; and distance from the CC exit to the distal cap. Septal CC are the safest and should be the default choice whenever possible.…”

Section: Selecting the Collateral Channelmentioning

confidence: 99%

Mastering retrograde coronary chronic total occlusion intervention in 2021

Dash¹

2021

J Transcat Intervent

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Chronic total occlusion recanalization still represents the last frontier in percutaneous coronary intervention. Retrograde recanalization is one of the most significant amendments of the technique, and has recently become an essential complement to the classical antegrade approach. It has a high success rate with a low complication profile, despite frequent utilization in the most complex patients. Since its initial description, important iterations have occurred and made the technique safer, faster and more successful.

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Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion

Abstract: In retrograde CTO percutaneous coronary intervention, only size and tortuosity of a CC are independent angiographic predictors of CC tracking and technical success.

Cited by 39 publications

References 28 publications

<p>Incidence, Predictors, and Strategies for Failure of Retrograde Microcatheter Tracking After Successful Wiring of Septal Collateral Channels in Chronic Total Occlusions</p>

<p>Incidence, Predictors, and Strategies for Failure of Retrograde Microcatheter Tracking After Successful Wiring of Septal Collateral Channels in Chronic Total Occlusions</p>

Nomogram to Predict Successful Septal Collateral Crossing during Percutaneous Coronary Intervention of Chronic Total Occlusion by retrograde approach: The Sep-CTO score

Mastering retrograde coronary chronic total occlusion intervention in 2021

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