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Collateral grading systems in retrograde percutaneous coronary intervention of chronic total occlusions

Yvemarie B O Somsen1, Ruben W de Winter1, Rocco Giunta2

  • 1Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 6, 2023
PubMed

Insights

The Japanese Channel (J-Channel) score shows promise for guiding retrograde percutaneous coronary intervention (PCI) in chronic total occlusions (CTOs). However, its ability to predict overall technical success in CTO PCI is limited, similar to other collateral grading systems.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Coronary Artery Disease

Background:

  • The Japanese Channel (J-Channel) score was developed to assist in retrograde percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTOs).
  • The predictive capabilities of the J-Channel score have not been compared against established collateral grading systems like the Rentrop classification and Werner grade.

Purpose of the Study:

  • To evaluate the predictive value of the J-Channel score, Rentrop classification, and Werner grade.
  • To assess their effectiveness in predicting successful collateral channel (CC) guidewire crossing and technical success in CTO PCI.

Main Methods:

  • A prospective study involving 600 patients undergoing CTO PCI.
  • Collateral grading systems were assessed using dual catheter injection.
  • Successful CC guidewire crossing and technical CTO PCI success were defined based on specific criteria.

Main Results:

  • The J-Channel score demonstrated predictive value for CC guidewire crossing, comparable to Rentrop classification and superior to Werner grade (AUC 0.743).
  • Technical CTO PCI success was achieved in 90% of patients.
  • Rentrop classification showed slightly better discrimination for technical success (0.676) than J-Channel (0.664) and Werner grade (0.589).

Conclusions:

  • The J-Channel score may assist in selecting collateral channels for retrograde CTO PCI.
  • All evaluated grading systems (J-Channel, Rentrop, Werner) have limited predictive value for the technical success of CTO PCI.
Abstract

Keywords:
chronic total coronary occlusionpercutaneous coronary interventionretrograde

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