title: The collateral circulation of coronary chronic total occlusions.
abstract: OBJECTIVE
  Despite advances in understanding the physiological role of collaterals in coronary chronic total occlusions (CTOs), collateral anatomy remains poorly defined. Our aim was to define the anatomy and interventional utility of collaterals within a large population of patients with CTOs.
  
  
  RESULTS
  We studied the coronary angiograms of 481 patients with 519 CTOs at six centres in the U.K. over four years. Detailed angiographic analysis was performed by interventional cardiologists specialising in CTO percutaneous coronary intervention (PCI). All visible collaterals with a collateral connection (CC) grade ≥1 were recorded. A subgroup of CTOs (n=277) was assessed for interventional capability, defined as whether the collateral supply was able to facilitate retrograde access. We described 45 different collateral patterns: 20 in right coronary artery (RCA), 13 in left anterior descending (LAD), and 12 in circumflex artery CTOs. Septal collaterals from the LAD to the right posterior descending artery (RPDA), and from the posterior descending artery to the LAD were most common, and most often considered as having "interventional capability".
  
  
  CONCLUSIONS
  This is the largest analysis of collateral circulation anatomy in a population of patients with CTOs. We anticipate that these data will be of significant benefit in angiographic analysis and procedure planning for CTO PCI.
authors.affiliation: Golden Jubilee National Hospital, Glasgow, United Kingdom.
authors.forename: Margaret B
authors.initials: MB
authors.lastname: McEntegart
authors.forename: Athar A
authors.initials: AA
authors.lastname: Badar
authors.forename: Faheem A
authors.initials: FA
authors.lastname: Ahmad
authors.forename: Aadil
authors.initials: A
authors.lastname: Shaukat
authors.forename: Michael
authors.initials: M
authors.lastname: MacPherson
authors.forename: John
authors.initials: J
authors.lastname: Irving
authors.forename: Julian
authors.initials: J
authors.lastname: Strange
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bagnall
authors.forename: Colm G
authors.initials: CG
authors.lastname: Hanratty
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Walsh
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.forename: James C
authors.initials: JC
authors.lastname: Spratt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology*; D054059:Coronary Occlusion / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome