Retrograde percutaneous coronary intervention of chronic total occlusion via discontinuous septal channels

Abstract Objectives The study aims to investigate the safety and feasibility of retrograde CTO intervention via collateral connection grade 0 (CC‐0) septal channel and to identify predictors of collateral tracking failure. Background Guidewire crossing a collateral channel is a critical step for successful retrograde percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Methods Retrograde PCI was attempted in 122 cases of CTO with CC‐0 septal collaterals from December 2018 to May 2021. A hydrophilic polymer coating guidewire was used for crossing all intended CC‐0 collaterals. A multivariable logistic regression analysis was performed to identify the predictors of guidewire tracking failure via the CC‐0 collaterals. Results Successful guidewire tracking via CC‐0 septal channel was achieved in 98 (80.3%) of 122 cases. The independent predictors of CC‐0 septal channel guidewire tracking failure included well‐developed non‐septal collateral (OR: 5.297, 95% CI: 1.107–25.353, p = 0.037) and the ratio length of posterior descending artery (PDA) versus the distance of PDA ostium to cardiac apex ≤2/3 (OR: 3.970, 95% CI: 1.454–10.835, p = 0.007). Collateral perforation, target vessel perforation, and cardiac tamponade occurred in 5 (4.1%), 3 (2.5%), and 6 (4.9%) cases, respectively. There were no complications requiring emergency cardiac surgery or revascularization of nontarget vessel. Conclusions Retrograde PCI via CC‐0 septal channels with a hydrophilic polymer‐coated guidewire is feasible and safe in patients with CTO. Well‐developed nonseptal collaterals and short PDA length influence the procedure success and the risk of guidewire tracking failure via CC‐0 septal channels.