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Published on: January 15, 2022
Angiographic Predictors of Septal Collateral Tracking During Retrograde Percutaneous Coronary Intervention for
Anna Maria Ioppolo1, Thomas Hovasse, Hakim Benamer
1Institut Cardiovasculaire Paris, Hôpital Privé Jacques Cartier, 6 avenue du Noyer Lambert, 91300 Massy, France. ioppoloannamaria@gmail.com.
Insights
Successful guidewire crossing in chronic total occlusion (CTO) retrograde approaches depends on collateral channel (CC) characteristics. The new R-ICPS score accurately predicts CC tracking success, outperforming existing methods.
Area of Science:
- Interventional Cardiology
- Vascular Imaging
- Medical Device Technology
Background:
- The retrograde approach is crucial for recanalizing complex chronic total occlusions (CTOs).
- Successful guidewire passage through collateral channels (CCs) is a critical procedural step.
- Existing scoring systems aim to predict CC tracking success.
Purpose of the Study:
- To identify independent angiographic predictors of collateral channel (CC) tracking success in CTO retrograde approach.
- To determine factors associated with microcatheter tracking failure and complications.
- To develop and validate a novel "crossability score" (R-ICPS) for predicting CC tracking success.
Main Methods:
- Retrospective analysis of 180 patients and 297 CCs in a retrograde CTO population.
- Evaluation of angiographic features including Werner score, tortuosity, and exit angle.
- Development and comparison of a new scoring model (R-ICPS) against pre-existing scores.
Main Results:
- Guidewire crossing was successful in 68.3% of CCs.
- Werner score 2 predicted successful tracking, while Werner score 0, severe tortuosity, acute exit angle, and CC length predicted failure.
- The developed R-ICPS score demonstrated higher predictive accuracy (AUC 0.72) than existing scores (AUC 0.65, 0.69).
- CC length was associated with microcatheter tracking failure and complications.
Conclusions:
- Angiographic factors like Werner score, tortuosity, exit angle, and CC length are key predictors of CC tracking success or failure.
- The R-ICPS score provides adequate accuracy for predicting collateral crossing.
- CC length is a significant factor for microcatheter crossing failure and procedural complications.
Objectives:
The aim of this study was to identify independent angiographic predictors of collateral channel (CC) tracking success, microcatheter tracking failure, and complications in chronic total occlusion (CTO) retrograde approach. We also developed a "crossability score," comparing its predictive performance with pre-existing scores.
Background:
The retrograde approach was introduced for recanalization of challenging CTOs. The passage of guidewires through CCs is a key step of the procedure. Two scoring systems have been recently developed to predict CC tracking success.
Methods:
A total of 180 patients and 297 CCs were retrospectively analyzed in an unselected retrograde CTO population.
Results:
Guidewire crossing was successful in 203 collaterals (68.3%). The only independent predictor of successful CC tracking was Werner score 2. Conversely, Werner score 0, severe tortuosity (>180°), acute exit angle (<90°), and length of collateral were independently associated with tracking failure. We assigned a score to each "significant" variable to create a model that showed a greater accuracy than pre-existing scores (area under the receiver-operator characteristics curve, 0.72 vs 0.65 and 0.69). Moreover, CC length was also associated with microcatheter tracking failure and complications.
Conclusions:
Werner score 0, tortuosity, acute exit angle, and CC length were independently associated with CC tracking failure, whereas Werner score 2 was a predictor of crossing success. Length of CC is associated with a higher rate of microcatheter crossing failure and complications. We combined these findings into the R-ICPS score, which showed an adequate accuracy for collateral crossing prediction.
