Incidence, Predictors, and Strategies for Failure of Retrograde Microcatheter Tracking After Successful Wiring of Septal Collateral Channels in Chronic Total Occlusions

Figures & data

Figure 1 Clinical management of procedure.

Abbreviations: MC, microcatheter; CC, collateral channels; CART, controlled antegrade and retrograde tracking.

Table 1 Clinical Characteristics of Study Population

Variables	Successful Group (n=236)	Failed Group (n=62)	P-value
Age(years)	63.5±9.2	64.2±8.9	0.719
Gender(female), n(%)	102(43.2%)	21(33.9%)	0.195
Body mass index (Kg/m^2)	22.3±3.1	23.2±3.3	0.628
Diabetes Mellitus, n(%)	87(36.9%)	20(32.3%)	0.554
Hypertension, n(%)	78(33.1%)	19(30.6%)	0.763
Dyslipidaemia on admission, n(%)	108(45.8%)	33(53.2%)	0.319
Current smoker, n(%)	99(41.9%)	28(45.2%)	0.667
Previous MI, n(%)	90(38.1%)	18(29.0%)	0.235
LVEF(%)	41.6±6.7	42.2±7.1	0.417
NYHA 2–3 on admission, n(%)	170(72.0%)	42(67.7%)	0.530

Abbreviations: MI, myocardial infarction; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.

Table 2 Procedural Characteristics and in Hospital MACCE of the Study Population

Variables	Successful Group (n=236)	Failed Group (n=62)	P-value
Procedural characteristics
Radial artery+ Femoral artery	184(78.0%)	46(74.2%)	0.610
Two femoral arteries	52(22.0%)	16(25.8%)
Previously antegrade failed, n(%)	65(27.5%)	12(19.4%)	0.253
In-stent CTO, n(%)	24(10.2%)	5(8.1%)	0.810
LAD-CTO, n(%)	158(66.9%)	32(51.6%)	0.037
CC tortuosity, n(%)	49(20.8%)	18(34.6%)	0.045
J-CTO score	2.5±0.8	2.6±0.9	0.371
Werner score 0–1, n(%)	52(22.0%)	11(17.7%)	0.600
Initial Corsair usage, n(%)	150(63.6%)	20(32.3%)	<0.001
Initial retrograde application of Guidezilla, n(%)	117(49.6%)	21(33.9%)	0.032
First attempt wire CC tracking success, n(%)	189(80.1%)	45(72.6%)	0.224
Procedural success, n(%)	222(94.1%)	58(93.5%)	0.773
Donor vessel dissection, n(%)	5(2.1%)	2(3.2%)	0.638
CC hematoma, n(%)	2(0.8%)	1(1.6%)	0.505
Target vessel perforation, n(%)	3(1.3%)	1(1.6%)	1
Cardiac tamponade, n(%)	2(0.8%)	1(1.6%)	0.505
In hospital MACCE
All cause mortality, n(%)	2(0.8%)	1(1.6%)	0.505
Acute in-stent thrombosis, n(%)	3(1.3%)	1(1.6%)	1
TVR, n(%)	3(1.3%)	1(1.6%)	1

Note: Bold values are statistically significant (p < 0.05).

Abbreviations: CTO, chronic total occlusion; LAD, left anterior descending artery; RCA, right coronary artery; CC, collateral channels; MACCE, major adverse cardiac and cerebral events; TVR, target vessel revascularization.

Figure 2 Clinical management of guidewire collateral channel tracking.

Table 3 Univariable and Multivariable Analyses for Angiographic Predictors of Initial Microcatheter CC Tracking Failure in Septal and Epicardial Collaterals

	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P value	OR	95% CI	P value
CC 0–1 collaterals	1.802	0.617–2.123	0.816	-	-	-
Severe collateral tortuosity	12.102	3.207–26.124	0.024	13.241	3.429–27.057	0.038
CC entry angle <90°	4.826	1.364–9.197	0.031	4.921	1.128–9.997	0.002
CC exit angle <90°	5.112	2.425–10.089	0.040	5.037	2.237–11.182	0.004
Finecross MG as initial microcatheter	1.968	1.320–2.907	0.032	1.826	1.127–3.067	0.035
Initial retrograde application of Guidezilla with strong support	0.383	0.208–0.829	0.027	0.321	0.267–0.915	0.024
RCA-LAD CC	1.369	0.803–2.019	0.627

Note: Bold values are statistically significant (p < 0.05).

Abbreviations: CC, collateral channels; RCA, right coronary artery; LAD, left anterior descending artery.

Figure 3 Clinical management of microcatheter collateral channel tracking.

Figure 4 The principle of collateral circulation selection.