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Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing
Yoriyasu Suzuki1, Makoto Muto2, Masahisa Yamane3
1Division of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan.
Insights
Successful retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is achievable, but lesion calcification independently predicts failure. Advanced techniques are needed to improve success rates in complex CTO cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The retrograde approach is crucial for percutaneous coronary intervention (PCI) in chronic total occlusion (CTO).
- Successful guidewire and catheter crossing of collateral channels is a prerequisite for the retrograde approach in CTO-PCI.
- Predicting failure after successful collateral crossing is essential for optimizing treatment strategies.
Purpose of the Study:
- To identify factors that predict failure in retrograde CTO-PCI even after successful collateral channel crossing.
- To evaluate the success rate of retrograde CTO-PCI in a large cohort.
- To determine independent predictors of retrograde CTO-PCI failure.
Main Methods:
- Analysis of 5984 CTO-PCI procedures from 45 Japanese centers (2009-2012).
- Focus on 1656 retrograde CTO-PCI procedures (27.7% of total).
- Investigation of factors predicting failure after successful collateral channel crossing using univariate and multivariate analyses.
Main Results:
- Successful collateral crossing was achieved in 77.1% of retrograde CTO-PCI cases.
- Retrograde procedural success was achieved in 89.4% after successful collateral crossing.
- Univariate analysis identified in-stent occlusion, calcified lesions, and lesion tortuosity as predictors of failure.
- Multivariate analysis revealed lesion calcification as an independent predictor of retrograde CTO-PCI failure (OR=1.3472).
Conclusions:
- The retrograde CTO-PCI approach demonstrates a high success rate following successful collateral channel crossing.
- Lesion calcification is a significant independent predictor of retrograde CTO-PCI failure.
- Further advancements in devices and techniques are necessary to manage complex CTO morphologies like calcification and enhance procedural success rates.
Objectives:
To evaluate factors for predicting retrograde CTO-PCI failure after successful collateral channel crossing.
Background:
Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
Methods:
A total of 5984 CTO-PCI procedures performed in 45 centers in Japan from 2009 to 2012 were studied. The retrograde approach was used in 1656 CTO-PCIs (27.7%). We investigated these retrograde procedures to evaluate factors for predicting retrograde CTO-PCI failure even after successful collateral channel crossing.
Results:
Successful guidewire/catheter collateral crossing was achieved in 77.1% (n = 1,276) of 1656 retrograde CTO-PCI procedures. Retrograde procedural success after successful collateral crossing was achieved in 89.4% (n = 1,141). Univariate analysis showed that the predictors for retrograde CTO-PCI failure were in-stent occlusion (OR = 1.9829, 95%CI = 1.1783 - 3.3370 P = 0.0088), calcified lesions (OR = 1.9233, 95%CI = 1.2463 - 2.9679, P = 0.0027), and lesion tortuosity (OR = 1.5244, 95%CI = 1.0618 - 2.1883, P = 0.0216). On multivariate analysis, lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing (OR = 1.3472, 95%CI = 1.0614 - 1.7169, P = 0.0141).
Conclusions:
The success rate of retrograde CTO-PCI following successful guidewire/catheter collateral channel crossing was high in this registry. Lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing. Devices and techniques to overcome complex CTO lesion morphology, such as lesion calcification, are required to further improve the retrograde CTO-PCI success rate. © 2016 Wiley Periodicals, Inc.
