Objectives: The aim of this study was to describe the procedural aspects and outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) through ipsilateral collateral channels (ILCs).
Background: Retrograde CTO PCI via ILCs is rarely performed, usually when no other retrograde options exist, and available evidence derives mostly from case reports.
Methods: A large retrospective multinational registry was compiled, including all consecutive patients undergoing retrograde CTO PCI through ILCs at 6 centers between September 2011 and October 2016. Success rates, as well as procedural complications and in-hospital outcomes, were studied.
Results: A total of 126 patients (17% of all retrograde CTO PCIs) were included. The mean age was 65.7 ± 11.2 years, and the mean J-CTO (Multicenter CTO Registry in Japan) score was 2.36 ± 1.13. The target vessel was the circumflex coronary artery in 42%, the left anterior descending coronary artery in 39%, and the right coronary artery in 19%. The ILCs used were epicardial in 76% and septal in 24%. ILC anatomy was very heterogeneous. One guiding catheter was used in 80%, whereas the ping-pong technique was used in 20%. A retrograde wire could be advanced to the distal cap in 81%. Technical and procedural success rates were 87% and 82%, respectively. ILC perforation with need for intervention was observed in 5.6% and tamponade due to ILC perforation in 2.4%. One patient (0.8%) died.
Conclusions: Retrograde CTO PCI through ILCs is a challenging intervention that can be performed in difficult occlusions with high success rates and reasonable rates of complications by experienced operators.
Keywords: chronic total occlusion; collateral channels; epicardial; ipsilateral; percutaneous coronary intervention; retrograde.
Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.