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Microcatheter collateral channel tracking failure in retrograde percutaneous coronary intervention for chronic total

Xin Zhong1, Lei Ge, Jianying Ma

  • 1Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|April 5, 2019
PubMed

Insights

Microcatheter collateral channel tracking failure occurred in 22.5% of retrograde percutaneous coronary intervention (PCI) procedures. Angiographic factors like collateral channel grade and entry/exit angles predicted failure, guiding management strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Retrograde percutaneous coronary intervention (PCI) is crucial for treating chronic total occlusions (CTOs).
  • Microcatheter manipulation within collateral channels (CCs) is a key step in retrograde PCI.
  • Failure to track CCs with a microcatheter can impede successful CTO revascularization.

Purpose of the Study:

  • To determine the incidence of microcatheter collateral channel (CC) tracking failure during retrograde PCI for CTOs.
  • To identify predictors of microcatheter CC tracking failure.
  • To describe management strategies employed after initial tracking failure.

Main Methods:

  • Retrospective analysis of prospectively collected data from 371 retrograde CTO-PCI procedures.
  • Focus on 280 procedures with initial wire CC tracking success.
  • Statistical analysis to identify independent predictors of microcatheter CC tracking failure.

Main Results:

  • Initial microcatheter CC tracking failure occurred in 22.5% of procedures.
  • For septal collaterals, predictors included CC grade 0-1, entry angle <90°, exit angle <90°, and specific microcatheter use.
  • For epicardial collaterals, CC 1 was the sole predictor.
  • Management involved microcatheter switching (61.9%) and adjunct techniques.

Conclusions:

  • Microcatheter CC tracking failure is a significant challenge in retrograde CTO-PCI, occurring in nearly a quarter of cases post-wire success.
  • Angiographic features like collateral quality and channel angles are key predictors.
  • Understanding these predictors aids in optimizing procedural strategy and success rates.
Abstract

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