The Impact of Epicardial Collateral Use on the Outcomes of Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention: Update from an International Registry
Presenter
Judit Karacsonyi, MD, PhD, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN
Judit Karacsonyi, MD, PhD1, Khaldoon Alaswad, M.D., FSCAI2, Dimitrios Karmpaliotis, M.D., FSCAI3, Jaikirshan Khatri, M.D., FSCAI4, Farouc A. Jaffer, M.D., Ph.D., FSCAI5, Oleg Krestyaninov, M.D.6, Evangelia Vemmou, M.D.7, Ilias Nikolakopoulos, M.D.1, Paul Poommipanit, M.D., FSCAI8, David E. Kandzari, M.D., FSCAI9, Wissam A Jaber, M.D., FSCAI10, Anthony Doing, MD11, M. Nicholas Burke, M.D.1, Ahmed Elguindy, MD12, Nidal Abi Rafeh, M.D.13, Ömer Göktekin, MD14, Bavana V Rangan, BDS, MPH15, Imre Ungi16 and Emmanouil S. Brilakis, MD, PhD, FSCAI1, (1)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (2)Henry Ford Hospital, Detroit, MI, (3)Atlantic Health Morristown Medical Center, Morristown , NJ, (4)Cleveland Clinic Main Campus, Cleveland, OH, (5)Massachusetts General Hospital, Boston, MA, (6)Federal State Institution Academician E.N.Meshalkin, Novosibirsk, Novosibirskaya oblast, Russian Federation, (7)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (8)University Hospitals Cleveland Medical Center, Beachwood, OH, (9)Piedmont Heart Institute, Atlanta, GA, (10)Emory University Hospital, Atlanta, GA, (11)Medical Center of the Rockies, Loveland, CO, (12)Magdi Yacoub Hospital, Cairo, Egypt, (13)Tulane University School of Medicine, New Orleans, LA, (14)Memorial Bahcelievler Hospital, Istanbul, Turkey, (15)Minneapolis Heart Institute Foundation, Minneapolis, MN, (16)University of Szeged, Szeged, Csongrad, Hungary
Keywords: Chronic Total Occlusion (CTO), Complex and High-risk Coronary Intervention (CHIP) and Coronary
Background:
The impact of collateral vessel on the outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
Methods:
We sought to examine the impact of collateral vessel used on the outcomes of retrograde CTO PCI. We reviewed the baseline clinical and angiographic characteristics and procedural outcomes of 2,346 retrograde CTO PCIs performed in 2,303 patients between 2012 and 2020 at 33 US and international centers.
Results:
Mean patient age was 64.8 ± 10 years and 84% were men. Septal collaterals or bypass grafts were used in 70%, and epicardial collaterals in 30%. Compared with cases in which only septal collaterals and bypass grafts were used, use of epicardial collaterals was more common in lesions with moderate/severe tortuosity (50% vs. 38%, p<0.0001), moderate/severe calcification (67% vs. 59%, p=0.0002), and higher Japan chronic total occlusion score (3.30 ± 1.03 vs. 3.08 ± 1.05, p<0.0001). Epicardial collateral use was associated with lower technical (76.3% vs. 80.0%, p=0.043) and procedural (72.1% vs. 77.8%, p=0.004) success rates, but similar incidence of major cardiac adverse events (4.89% vs. 3.98%, p=0.325). Epicardial collaterals were associated with more perforations (13.50% vs. 8.59%, p=0.0003) and tamponade (1.87% vs. 0.87%, p=0.041).
Conclusions:
In a contemporary, international registry epicardial collaterals were used in approximately one-third of retrograde CTO PCIs. Use of epicardial collaterals was associated with lower success and similar overall major complication rates, but higher risk of perforation and tamponade.
