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Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic
Ching-Chang Huang1, Chih-Kuo Lee1, Shih-Wei Meng1
1From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.).
Insights
Selecting collateral channels for retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is crucial. Large size and lack of tortuosity in collateral channels are key predictors of successful CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Limited evidence exists for selecting interventional collateral channels (CCs) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Identifying predictors for CC tracking and technical success is essential for improving retrograde CTO PCI outcomes.
Purpose of the Study:
- To identify independent angiographic predictors of collateral channel (CC) tracking and technical success in retrograde CTO PCI.
- To develop a predictive model for CC selection in retrograde CTO PCI.
Main Methods:
- Analysis of 216 consecutive retrograde CTO PCI attempts from January 2012 to December 2015.
- Evaluation of angiographic characteristics including channel type, size, tortuosity, angle of attack, and length.
- Multivariable analysis to determine independent predictors of CC tracking and technical success.
Main Results:
- CC tracking success rate was 83.5%, with a per-CC technical success rate of 81.4% and a per-patient success rate of 91.2%.
- Large channel size and lack of tortuosity were identified as significant independent predictors of CC tracking and technical success.
- A novel scoring system based on size and tortuosity demonstrated predictive accuracy (ROC AUC 0.800 for tracking, 0.752 for technical success).
Conclusions:
- Collateral channel size and tortuosity are the primary independent angiographic predictors for successful tracking and technical outcomes in retrograde CTO PCI.
- The developed scoring system can aid in selecting optimal collateral channels for retrograde CTO PCI.
Background:
There is little evidence on how to select an interventional collateral channel (CC) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention. We aimed to identify independent angiographic predictors of CC tracking and technical success in retrograde CTO percutaneous coronary intervention.
Methods And Results:
From January 2012 to December 2015, a total of 216 consecutive retrograde CTO percutaneous coronary intervention attempts by a high-volume operator in a tertiary university-affiliated hospital were enrolled. The clinical, angiographic, and procedural details were collected. The characteristics analyzed included channel type, size, tortuosity, angle of attack, length to emerging point, and the Multicenter CTO Registry of Japan score. The Multicenter CTO Registry of Japan score was 4.2±0.8. A total of 242 CCs were attempted for intervention. CC tracking success rate was 83.5%, and the technical success rate (per CC) was 81.4%. The per-patient technical success rate was 91.2%, and the major procedural complication rate was 4.6%. The atrioventricular groove, epicardial, and septal CCs were used in 36 (14.9%), 84 (34.7%), and 122 (50.4%) tracking attempts, respectively. In multivariable analysis, only large channel size and lack of tortuosity were significant independent predictors of CC tracking and technical success. A new scoring system was developed, while large size was given 1 point and lack of tortuosity was given 2 points. The receiver-operating characteristic area by the new model to predict CC tracking and technical success were 0.800 and 0.752, respectively.
Conclusions:
In retrograde CTO percutaneous coronary intervention, only size and tortuosity of a CC are independent angiographic predictors of CC tracking and technical success.
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