Retrograde percutaneous coronary intervention of chronic total occlusion via discontinuous septal channels

Abstract

Objectives The study aims to investigate the safety and feasibility of retrograde CTO intervention via collateral connection grade 0 (CC‐0) septal channel and to identify predictors of collateral tracking failure. Background Guidewire crossing a collateral channel is a critical step for successful retrograde percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Methods Retrograde PCI was attempted in 122 cases of CTO with CC‐0 septal collaterals from December 2018 to May 2021. A hydrophilic polymer coating guidewire was used for crossing all intended CC‐0 collaterals. A multivariable logistic regression analysis was performed to identify the predictors of guidewire tracking failure via the CC‐0 collaterals. Results Successful guidewire tracking via CC‐0 septal channel was achieved in 98 (80.3%) of 122 cases. The independent predictors of CC‐0 septal channel guidewire tracking failure included well‐developed non‐septal collateral (OR: 5.297, 95% CI: 1.107–25.353, p = 0.037) and the ratio length of posterior descending artery (PDA) versus the distance of PDA ostium to cardiac apex ≤2/3 (OR: 3.970, 95% CI: 1.454–10.835, p = 0.007). Collateral perforation, target vessel perforation, and cardiac tamponade occurred in 5 (4.1%), 3 (2.5%), and 6 (4.9%) cases, respectively. There were no complications requiring emergency cardiac surgery or revascularization of nontarget vessel. Conclusions Retrograde PCI via CC‐0 septal channels with a hydrophilic polymer‐coated guidewire is feasible and safe in patients with CTO. Well‐developed nonseptal collaterals and short PDA length influence the procedure success and the risk of guidewire tracking failure via CC‐0 septal channels.

Scoring system related to retrograde percutaneous coronary intervention for coronary chronic total occlusion

“…They revealed that a CC diameter <1 mm, well-developed non-septal collateral, and LAD-CTO were independent predictors of guidewire tracking failure in patients undergoing retrograde CTO-PCI via poor septal CCs. Moreover, our recent study [26] demonstrated that retrograde CTO-PCI via CC0 septal CCs with a hydrophilic polymer-coated guidewire was feasible and safe in CTO patients, achieving a high success rate of CCs tracking and procedure. These findings suggest that small or invisible CCs should not deter operators from attempting retrograde CTO-PCI.…”

Incidence, Predictors, and Strategies for Retrograde Wire Tracking Failure via Poor Septal Collateral Channels in Chronic Total Occlusion

“… 5 In the present study, the incidence of GW tracking success via poor septal CC was 77.9% (95/122), which is similar to that in a recent study. 9 …”

“… 5 A recent study from China suggested that retrograde PCI via CC0 septal collaterals is feasible and safe, and that well-developed non-septal CC and short post descending artery length were independent predictors for GW tracking success via CC0 septal channels. 9 Despite these studies, the predictors of retrograde GW crossing failure via poor septal CC remain unclear.…”

“Crossing the invisible”

“…In this context, Zhang et al 5 assessed the safety and feasibility of retrograde CTO intervention using "discontinuous collaterals" (CC0).…”

“…In this context, Zhang et al 5 assessed the safety and feasibility of retrograde CTO intervention using “discontinuous collaterals” (CC0). Of the 456 cases where any retrograde attempt was made during CTO percutaneous coronary intervention (PCI) by a single high‐volume operator from December 2019 to May 2021, they identified that CC0 septal collateral was used in 122 cases (26.8%).…”