Abstract 3797: Coronary Septal Collaterals as an Access for the Retrograde Approach in the Percutaneous Treatment of Coronary Chronic Total Occlusions
Background: Despite improvements in percutaneous techniques and materials, CTO recanalization success rate is still suboptimal. The retrograde approach allows to significantly increase this success rate. However, its application via a bypass graft or epicardial collateral can potentially result in severe complications. A safer retrograde access is therefore desired. Hypothesis: To investigate the feasibility and safety of the percutaneous dilatation of coronary septal collaterals to allow their uses as an access for retrograde approach to percutaneous coronary intervention (PCI) of CTOs.
Methods: After a failed antegrade CTO recanalization attempt, a retrograde approach via septal collaterals was tried in 21 patients (19 males, 2 females). The septal collateral was accessed via the contra-lateral patent coronary artery and was crossed with a hydrophilic floppy wire. After successful wire crossing of the septal collateral, sequential low pressure dilatation was performed with a 1.25 or 1.5 mm balloon, in order to allow the delivery of a balloon catheter up to the distal CTO site. Pre- and post-dilatation example with OCT images shown in figure⇓.
Results: Successful wire crossing and balloon dilatation of septal collaterals was achieved in 19 cases and in 17 cases respectively. Post dilatation septal collateral diameter increased significantly reaching a mean diameter of 1.46 ± 0.38 mm. Retrograde CTO recanalization was successfully performed in 71% of the cases. No major complications occurred.
Conclusions: Coronary septal collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTOs.