Independent predictors of retrograde failure in CTO‐PCI after successful collateral channel crossing

Objectives To evaluate factors for predicting retrograde CTO‐PCI failure after successful collateral channel crossing. Background: Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods A total of 5984 CTO‐PCI procedures performed in 45 centers in Japan from 2009 to 2012 were studied. The retrograde approach was used in 1656 CTO‐PCIs (27.7%). We investigated these retrograde procedures to evaluate factors for predicting retrograde CTO‐PCI failure even after successful collateral channel crossing. Results Successful guidewire/catheter collateral crossing was achieved in 77.1% ( n = 1,276) of 1656 retrograde CTO‐PCI procedures. Retrograde procedural success after successful collateral crossing was achieved in 89.4% ( n = 1,141). Univariate analysis showed that the predictors for retrograde CTO‐PCI failure were in‐stent occlusion (OR = 1.9829, 95%CI = 1.1783 – 3.3370 P = 0.0088), calcified lesions (OR = 1.9233, 95%CI = 1.2463 – 2.9679, P = 0.0027), and lesion tortuosity (OR = 1.5244, 95%CI = 1.0618 – 2.1883, P = 0.0216). On multivariate analysis, lesion calcification was an independent predictor of retrograde CTO‐PCI failure after successful collateral channel crossing (OR = 1.3472, 95%CI = 1.0614 – 1.7169, P = 0.0141). Conclusions The success rate of retrograde CTO‐PCI following successful guidewire/catheter collateral channel crossing was high in this registry. Lesion calcification was an independent predictor of retrograde CTO‐PCI failure after successful collateral channel crossing. Devices and techniques to overcome complex CTO lesion morphology, such as lesion calcification, are required to further improve the retrograde CTO‐PCI success rate. © 2016 Wiley Periodicals, Inc.