Collateral channel crossing failure during retrograde chronic total occlusion percutaneous coronary intervention: predictors and associated procedural outcomes from a multicenter registry
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Published on: May 26, 2023
Semi Ozturk1, Ahmet Seyfeddin Gurbuz2, Sule Goktekin3
1Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey;
Objectives:
Retrograde chronic total occlusion percutaneous coronary intervention (CTO PCI) may fail at several stages. The authors evaluated factors associated with collateral channel crossing failure during retrograde CTO PCI and its associations with technical success and procedural complications.
Methods:
The authors analyzed procedures from a multicenter CTO PCI registry with attempted retrograde or retrograde-assisted strategies and recorded the retrograde result. The primary endpoint was collateral channel crossing failure. Secondary endpoints included retrograde success, overall technical success, collateral/coronary perforation, donor-vessel injury, vascular complications, and an extended complication composite.
Results:
Among 577 retrograde CTO PCI procedures with recorded retrograde result, retrograde success was achieved in 375 (65.0%), and collateral channel crossing failure occurred in 135 (23.4%). Overall technical success was lower with collateral crossing failure than without it (51.9% vs 88.7%), with higher rates of collateral and coronary perforation, vascular complications, and the extended complication composite. In the primary adjusted model restricted to procedures with known collateral connection (CC) grade, corkscrew collateral morphology (adjusted odds ratio [OR], 6.85; 95% CI, 3.63-12.91) and CC0 grade (adjusted OR, 4.70; 95% CI, 1.97-11.26) were associated with higher odds of crossing failure, whereas CC2/CC3 grade was associated with lower odds (adjusted OR, 0.45; 95% CI, 0.22-0.92).
Conclusions:
Collateral channel crossing failure was common in retrograde CTO PCI and was associated with lower technical success and greater complication burden. Unfavorable collateral morphology was associated with a higher risk of crossing failure; repeated collateral attempts may indicate escalating procedural difficulty and may warrant strategy reassessment.
