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THE IMPACT OF EPICARDIAL COLLATERAL USE ON THE OUTCOMES OF CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM A CONTEMPORARY MULTICENTER REGISTRY
1319 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology THE IMPACT OF EPICARDIAL COLLATERAL USE ON THE OUTCOMES OF CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM A CONTEMPORARY MULTICENTER REGISTRY Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Advances in Chronic Total Occlusion Intervention Abstract Category: 20. Interventional Cardiology: Coronary Intervention: CTO Presentation Number: 1282-122 Authors: Judit Karacsonyi, Khaldoon Alaswad, Farouc Jaffer, Robert Yeh, Dimitrios Karmpaliotis, Jeffrey Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, David Kandzari, Nicholas Lembo, William Lombardi, R. Michael Wyman, Anthony Doing, Catalin Toma, James Choi, Mitul Patel, Ehtisham Mahmud, Barry Uretsky, Aris Karatasakis, Bavana Rangan, Imre Ungi, Craig Thompson, Subhash Banerjee, Emmanouil Brilakis, University of Texas Southwestern Medical Center and Dallas VA Medical Center, Dallas, TX, USA Background: We examined the impact of the type of collateral vessel used on the outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: The baseline clinical and angiographic characteristics and procedural outcomes of 704 retrograde CTO PCIs performed between 2012 and 2016 at 14 US centers in 700 patients were examined. Results: Mean patient age was 65.8 ± 10 years, 87% were men. Septal collaterals were used in 63%, epicardial in 35% and bypass grafts in 16% of lesions. Compared with cases in which only septal collaterals and saphenous vein grafts were used, use of epicardial collaterals were associated with longer occlusion length (40 [25; 68] vs. 38 [23; 60] mm, p=0.015), more moderate/severe tortuosity (52% vs. 41%, p=0.009), and higher Japanese total occlusion scores (3.37 ± 0.95 vs. 3.06 ± 1.03, p<0.0001). Epicardial collateral use was associated with lower technical (77.5% vs. 86.1%, p=0.004) and procedural (72.4% vs. 82.3%, p=0.002) success rates, but similar incidence of major cardiac adverse events (4.53% vs. 5.69%, p=0.513). Epicardial collateral use was also associated with longer fluoroscopy time (80 [59; 106] vs. 73 [52; 102] min, p=0.010) and larger contrast volume (310 [240; 450] ml vs. 300 [215; 400] ml, p=0.016). Conclusions: In a contemporary, multicenter registry epicardial collaterals were used in approximately one-third of retrograde CTO PCIs. Use of epicardial collaterals was associated with lower success but similar complication rates.
Interventional Cardiology THE IMPACT OF EPICARDIAL COLLATERAL USE ON THE OUTCOMES OF CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM A CONTEMPORARY MULTICENTER REGISTRY Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Advances in Chronic Total Occlusion Intervention Abstract Category: 20. Interventional Cardiology: Coronary Intervention: CTO Presentation Number: 1282-122 Authors: Judit Karacsonyi, Khaldoon Alaswad, Farouc Jaffer, Robert Yeh, Dimitrios Karmpaliotis, Jeffrey Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, David Kandzari, Nicholas Lembo, William Lombardi, R. Michael Wyman, Anthony Doing, Catalin Toma, James Choi, Mitul Patel, Ehtisham Mahmud, Barry Uretsky, Aris Karatasakis, Bavana Rangan, Imre Ungi, Craig Thompson, Subhash Banerjee, Emmanouil Brilakis, University of Texas Southwestern Medical Center and Dallas VA Medical Center, Dallas, TX, USA Background: We examined the impact of the type of collateral vessel used on the outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: The baseline clinical and angiographic characteristics and procedural outcomes of 704 retrograde CTO PCIs performed between 2012 and 2016 at 14 US centers in 700 patients were examined. Results: Mean patient age was 65.8 ± 10 years, 87% were men. Septal collaterals were used in 63%, epicardial in 35% and bypass grafts in 16% of lesions. Compared with cases in which only septal collaterals and saphenous vein grafts were used, use of epicardial collaterals were associated with longer occlusion length (40 [25; 68] vs. 38 [23; 60] mm, p=0.015), more moderate/severe tortuosity (52% vs. 41%, p=0.009), and higher Japanese total occlusion scores (3.37 ± 0.95 vs. 3.06 ± 1.03, p<0.0001). Epicardial collateral use was associated with lower technical (77.5% vs. 86.1%, p=0.004) and procedural (72.4% vs. 82.3%, p=0.002) success rates, but similar incidence of major cardiac adverse events (4.53% vs. 5.69%, p=0.513). Epicardial collateral use was also associated with longer fluoroscopy time (80 [59; 106] vs. 73 [52; 102] min, p=0.010) and larger contrast volume (310 [240; 450] ml vs. 300 [215; 400] ml, p=0.016). Conclusions: In a contemporary, multicenter registry epicardial collaterals were used in approximately one-third of retrograde CTO PCIs. Use of epicardial collaterals was associated with lower success but similar complication rates.