Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing

Catheter Cardiovasc Interv. 2017 Jul;90(1):E11-E18. doi: 10.1002/ccd.26785. Epub 2016 Sep 21.

Abstract

Objectives: To evaluate factors for predicting retrograde CTO-PCI failure after successful collateral channel crossing.

Background: Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods: A total of 5984 CTO-PCI procedures performed in 45 centers in Japan from 2009 to 2012 were studied. The retrograde approach was used in 1656 CTO-PCIs (27.7%). We investigated these retrograde procedures to evaluate factors for predicting retrograde CTO-PCI failure even after successful collateral channel crossing.

Results: Successful guidewire/catheter collateral crossing was achieved in 77.1% (n = 1,276) of 1656 retrograde CTO-PCI procedures. Retrograde procedural success after successful collateral crossing was achieved in 89.4% (n = 1,141). Univariate analysis showed that the predictors for retrograde CTO-PCI failure were in-stent occlusion (OR = 1.9829, 95%CI = 1.1783 - 3.3370 P = 0.0088), calcified lesions (OR = 1.9233, 95%CI = 1.2463 - 2.9679, P = 0.0027), and lesion tortuosity (OR = 1.5244, 95%CI = 1.0618 - 2.1883, P = 0.0216). On multivariate analysis, lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing (OR = 1.3472, 95%CI = 1.0614 - 1.7169, P = 0.0141).

Conclusions: The success rate of retrograde CTO-PCI following successful guidewire/catheter collateral channel crossing was high in this registry. Lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing. Devices and techniques to overcome complex CTO lesion morphology, such as lesion calcification, are required to further improve the retrograde CTO-PCI success rate. © 2016 Wiley Periodicals, Inc.

Keywords: chronic total occlusion; percutaneous coronary intervention; retrograde approach.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Collateral Circulation*
  • Coronary Angiography
  • Coronary Circulation*
  • Coronary Occlusion / diagnostic imaging
  • Coronary Occlusion / physiopathology
  • Coronary Occlusion / therapy*
  • Coronary Restenosis / etiology
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / physiopathology*
  • Female
  • Humans
  • Japan
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Percutaneous Coronary Intervention / adverse effects*
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Treatment Failure
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / physiopathology
  • Vascular Calcification / therapy*