title: Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan.
authors.forename: Yoriyasu
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Division of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Muto
authors.affiliation: Cardiology Department, Saitama Sekishinkai Hospital, Saitama, Japan.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Yamane
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Division Of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Okamura
authors.affiliation: Cardiovascular Center, Japan Community Health care Organization Hokkaido Hosptal, Hokkaido, Japan.
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Igarashi
authors.affiliation: Division of Cardiology, Sapporo Cardiovascular Clinic, Hokkaido, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Cardiovascular Center, Kyoto Katsura Hospital, Kyoto, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, Takase Clinic, Gunma, Japan.
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Oida
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Aichi, Japan.
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*
keywords: chronic total occlusion; percutaneous coronary intervention; retrograde approach