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Incidence, Predictors, and Strategies for Retrograde Wire Tracking Failure via Poor Septal Collateral Channels in

Cheng-Fu Wang1, Bao-Jun Chen1, Bo Luan1

  • 1Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, People's Republic of China.

Clinical Interventions in Aging
|September 19, 2023
PubMed

Insights

Retrograde guidewire tracking failure during coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) via poor septal collateral channels (CC) occurred in 22.1% of patients. Key predictors included small CC diameter, well-developed non-septal collaterals, and left anterior descending artery CTO.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Successful revascularization of coronary chronic total occlusion (CTO) often relies on retrograde guidewire (GW) tracking through septal collateral channels (CC) when antegrade approaches fail.
  • However, the specific challenges, predictors, and management of retrograde GW tracking failure via poor septal CC remain incompletely understood.

Purpose of the Study:

  • To investigate the incidence, predictors, and outcomes of retrograde GW tracking failure in patients undergoing CTO percutaneous coronary intervention (PCI) using a poor septal CC.
  • To identify factors associated with successful retrograde GW manipulation in complex CTO cases.

Main Methods:

  • A retrospective analysis of 122 CTO patients who underwent retrograde septal PCI with poor CC between January 2017 and May 2022.
  • Patients were categorized into successful and failure groups for retrograde GW tracking, with clinical and angiographic data compared to identify predictors of failure.

Main Results:

  • The incidence of retrograde GW tracking failure was 22.1%.
  • Failure was associated with left anterior descending artery (LAD) CTO, well-developed non-septal collaterals, a septal CC diameter < 1 mm, and fewer than 3 septal CCs.
  • Logistic regression identified CC diameter < 1 mm, well-developed non-septal collateral, and LAD CTO as independent predictors of GW tracking failure.

Conclusions:

  • Retrograde GW tracking via poor septal CC can achieve a high success rate in CTO PCI.
  • Identifying predictors like small CC diameter, extensive non-septal collaterals, and LAD CTO is crucial for anticipating and managing GW tracking failure.
Abstract

Keywords:
PCIcoronary chronic total occlusionretrogradeseptal collateral channels

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