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Retrograde chronic total occlusion percutaneous coronary intervention via ipsilateral collaterals

Ahmed Al-Ogaili1, Michaella Alexandrou1, Athanasios Rempakos1

  • 1Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 2, 2024
PubMed

Insights

Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using ipsilateral epicardial collaterals (IEC) shows similar success rates but increased complications compared to other collateral types.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Coronary Artery Disease

Background:

  • Limited data exists on retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) utilizing ipsilateral epicardial collaterals (IEC).
  • Understanding the feasibility and outcomes of IEC in retrograde CTO PCI is crucial for expanding treatment options.

Purpose of the Study:

  • To compare the clinical, angiographic characteristics, and outcomes of retrograde CTO PCI via IEC versus other collateral pathways.
  • To evaluate the safety and efficacy of using IEC for complex coronary interventions.

Main Methods:

  • An observational cohort study utilizing data from the Prospective Global registry for the study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
  • Analysis of 4466 retrograde CTO PCI cases, with a specific focus on 191 cases using IEC.
  • Comparison of procedural success, technical success, and complication rates between IEC and non-IEC collateral groups.

Main Results:

  • Wiring success for IEC was 50%. The left circumflex artery was the most common target in the IEC group.
  • Technical (76% vs. 79%) and procedural success rates (74% vs. 79%) were comparable between IEC and other collateral groups.
  • IEC cases exhibited a significantly higher rate of periprocedural complications (25.8% vs. 16.4%), including perforations and pericardiocentesis.

Conclusions:

  • Retrograde CTO PCI via IEC achieves similar technical and procedural success rates as other collateral approaches.
  • The use of IEC is associated with a higher incidence of periprocedural complications, necessitating careful consideration and technique.
Abstract

Keywords:
chronic total occlusionipsilateral collateralspercutaneous coronary interventionretrograde approach

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