Temporal Trends in Retrograde Crossing of Epicardial Collaterals in Chronic Total Occlusion Percutaneous Coronary Intervention

J Invasive Cardiol. 2022 Apr;34(4):E294-E295. doi: 10.25270/jic/21.00434. Epub 2022 Mar 18.

Abstract

Background: The use of retrograde crossings in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) provides higher technical success rates in CTO-PCI. However, the use of epicardial collaterals carries a higher complication risk.

Methods and results: In this study, we aimed to investigate the temporal trends in retrograde crossing of epicardial collaterals, introduction of new guidewires, in-hospital major adverse cardiovascular events (MACE), and technical success rates in a large, multinational registry. We demonstrate that technical success rates increased substantially from about 5%-10% to 76% in the past decade without a concomitant increase in MACE rate (~3% to 4%), likely associated with increased operator experience and introduction of new guidewires. In addition, we show that while high-volume centers have higher technical success, they also have higher perforation rates.

Keywords: CTO-PCI; epicardial collaterals; retrograde approach.

MeSH terms

  • Chronic Disease
  • Coronary Angiography / methods
  • Coronary Occlusion* / diagnosis
  • Coronary Occlusion* / etiology
  • Coronary Occlusion* / surgery
  • Humans
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Registries
  • Risk Factors
  • Treatment Outcome