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Piedimonte G, Azzalini L, Ferrarotto L, Mangione R, Cerrato E, Franzè A, Tomassini F, Rolfo C, Pavani M, Zanda G, Tamburino C, Varbella F, La Manna A. Applicability of J-CTO channel score to predict microcatheter tracking during retrograde percutaneous coronary intervention of chronic total occlusions: Insights from the SURFING MICRO registry. Catheter Cardiovasc Interv 2024; 103:1-11. [PMID: 38050646 DOI: 10.1002/ccd.30928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/24/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The J-chronic total occlusion (CTO) channel score can predict guidewire tracking of the collateral channels (CCs), but its efficacy in predicting microcatheter tracking has never been tested in the setting of retrograde CTO-percutaneous coronary intervention (PCI). AIMS Predicting microcatheter collateral tracking during retrograde CTO-PCIs. METHODS A total of 189 patients undergoing retrograde CTO-PCI from April 2017 to August 2021 were screened. The primary outcome of interest was a correlation between J-CTO channel score and microcatheter tracking failure (MTF) after successful CC tracking by the guidewire. The independent association between anatomical features of the J-CTO channel score and the primary outcome of interest was explored. RESULTS After adjustment, only small size (adjusted OR: 12.70, 95% confidence interval [CI]: 1.79-89.82; p = 0.01) and continuous bends (adjusted OR: 14.15, 95% CI: 2.77-72.34; p < 0.001) remained significantly associated with an increased risk of MTF for septal collaterals. The small size was the only predictor of the MTF for epicardial collaterals (OR: 6.39, 95% CI: 1.13-35.96; p = 0.020) at univariate analysis. Patients in the MTF group had a lower incidence of procedural success compared with patients in the microcatheter tracking success (MTS) group (40.0% vs. 93.9%, p < 0.001) and had a higher incidence of collateral perforations (20.0% vs. 3.0%, p < 0.001). CONCLUSION Small and tortuous septal collaterals, identified by a score ≥3, are associated with an increased risk of MTF, lower incidence of procedural success, and higher risk of procedural complications driven by collateral perforations.
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Affiliation(s)
- Giulio Piedimonte
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Lorenzo Azzalini
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Luigi Ferrarotto
- Division of Cardiology, Interventional Unit-Azienda Ospedaliero Universitaria Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Riccardo Mangione
- Division of Cardiology, Interventional Unit-Azienda Ospedaliero Universitaria Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Enrico Cerrato
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Alfonso Franzè
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Francesco Tomassini
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Cristina Rolfo
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Marco Pavani
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Greca Zanda
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Corrado Tamburino
- Division of Cardiology, Interventional Unit-Azienda Ospedaliero Universitaria Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Ferdinando Varbella
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Alessio La Manna
- Division of Cardiology, Interventional Unit-Azienda Ospedaliero Universitaria Policlinico "G.Rodolico-San Marco", Catania, Italy
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Wang CF, Chen BJ, Luan B, Wang Y, Zhang XJ, Qu HB. Incidence, Predictors, and Strategies for Retrograde Wire Tracking Failure via Poor Septal Collateral Channels in Chronic Total Occlusion. Clin Interv Aging 2023; 18:1503-1512. [PMID: 37724173 PMCID: PMC10505379 DOI: 10.2147/cia.s424882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
Background Retrograde guidewire (GW) tracking success via a poor septal collateral channel (CC) when an antegrade approach fails is crucial for successful revascularization of coronary chronic total occlusion (CTO) with poor septal CC. However, the incidence, predictors, and management strategies for retrograde GW tracking failure via poor septal CC remain unclear. Methods In total, 122 CTO patients who underwent retrograde septal percutaneous coronary intervention (PCI) with poor CC between January 2017 and May 2022 were retrospectively analyzed. Patients were divided into the retrograde GW tracking success group (success group) and the retrograde GW tracking failure group (failure group). Clinical and angiographic data were compared to investigate the predictors of retrograde GW tracking failure. Results The incidence of GW tracking failure was 22.1% (27/122). Patients in the failure group had a higher prevalence of left anterior descending artery (LAD) CTO (66.7% vs 37.9%; p = 0.009) and a higher incidence of well-developed non-septal collateral (66.7% vs 30.5%; p = 0.001). Patients with a septal CC diameter ≥ 1 mm (48.1% vs 70.5%; p = 0.040), ≥ 3 septal CCs (44.4% vs 66.3%; p = 0.046), and initial retrograde application of Guidezilla (37.0% vs 60.0%; p = 0.048) were significantly lower in the failure group than in the success group. The binary logistics regression model showed that a CC diameter < 1 mm, well-developed non-septal collateral, and LAD CTO were independent predictors for GW tracking failure in patients undergoing retrograde CTO PCI via poor septal CC. Conclusion The success rate of retrograde GW tracking via poor septal CC was high, with a relatively high procedural success rate. A CC diameter < 1 mm, well-developed non-septal collateral, and LAD CTO were independent predictors of GW tracking failure in patients undergoing retrograde CTO PCI via poor septal CC.
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Affiliation(s)
- Cheng-Fu Wang
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, People’s Republic of China
| | - Bao-Jun Chen
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, People’s Republic of China
| | - Bo Luan
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, People’s Republic of China
| | - Yong Wang
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People’s Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, People’s Republic of China
| | - Xiao-Jiao Zhang
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, People’s Republic of China
| | - Hai-Bo Qu
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, People’s Republic of China
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