Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions.
OBJECTIVE
To investigate the feasibility and safety of the percutaneous dilatation of coronary septal collaterals and to allow its use as an access for retrograde approach to percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs).


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 desired and would allow broadening the application of the retrograde approach in the percutaneous treatment 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 contralateral 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 to allow the delivery of a balloon catheter up to the distal CTO site.


RESULTS
Successful wire crossing and balloon dilatation of septal collaterals was achieved in 19 cases and in 17 cases, respectively. Postdilatation 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.
Surmely
Jean-François
JF
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan. j-f.surmely@heart-center.or.jp
Katoh
Osamu
O
Tsuchikane
Etsuo
E
Nasu
Kenya
K
Suzuki
Takahiko
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012086:Reoperation; D016896:Treatment Outcome; D014654:Vascular Patency