Coronary angioplasty of chronic total occlusions with bridging collateral vessels: immediate and follow-up outcome from a large single-center experience

Department of Cardiology, Center for Adult Diseases, Osaka, Japan.

OBJECTIVES. The purpose of the present study was to assess the effect of bridging collateral vessels on the success of coronary angioplasty of chronic total occlusions in the context of state of the art technology and operator skill. BACKGROUND. Coronary angioplasty of chronic total occlusions has been associated with relatively low success rates. Because the presence of bridging collateral vessels in chronic total occlusion has been reported to be the major predictive factor in procedural failure, angioplasty is often not recommended in patients with such vessels. METHODS. Three hundred ninety-seven consecutive patients undergoing coronary angioplasty for chronic total occlusion were classified into two groups. Patients in group I had chronic total occlusion with bridging collateral vessels (97 patients, 109 total occlusions), and patients in group II had chronic total occlusion without such vessels (300 patients, 324 total occlusions). RESULTS. The mean +/- SD duration of occlusion was 46 +/- 66 months (range 2 to 170) in group I and 27 +/- 39 months (range 2 to 112) in group II (p < 0.05, high power value 0.83, group I vs. group II). Angioplasty for single-vessel disease was performed in a smaller proportion of patients in group I than in group II (22% vs. 36%, p < 0.05; power value 0.77). Procedural success was achieved in 82 chronic total occlusions in group I and 270 chronic total occlusions in group II (75% vs. 83%, p = 0.07; power value 0.53). The rates of restenosis and reocclusion were 54% and 16%, respectively, for group I and 56% and 13%, respectively, for group II (p = 0.76, 0.46; power value 0.51, 0.47). Complications were minor with no Q wave infarction or requirement for urgent bypass surgery in either group. Of 81 patients with unsuccessful coronary angioplasty, 1 patient from group I (1%) and 3 patients from group II (1%) required pericardiocentesis because of cardiac tamponade. Guide wire manipulation did not impair the flow of bridging collateral channels in group I. CONCLUSIONS. Coronary angioplasty can open chronic total occlusions, with or without bridging collateral channels, for safe and effective recanalization without major complications.

This article has been cited by other articles:

				P. B. Shah Management of Coronary Chronic Total Occlusion Circulation, April 26, 2011; 123(16): 1780 - 1784. [Full Text] [PDF]

				S. Rathore, O. Katoh, E. Tuschikane, A. Oida, T. Suzuki, and S. Takase A Novel Modification of the Retrograde Approach for the Recanalization of Chronic Total Occlusion of the Coronary Arteries: Intravascular Ultrasound-Guided Reverse Controlled Antegrade and Retrograde Tracking J. Am. Coll. Cardiol. Intv., February 1, 2010; 3(2): 155 - 164. [Abstract] [Full Text] [PDF]

				M. Kimura, O. Katoh, E. Tsuchikane, K. Nasu, Y. Kinoshita, M. Ehara, M. Terashima, H. Matsuo, T. Matsubara, K. Asakura, et al. The Efficacy of a Bilateral Approach for Treating Lesions With Chronic Total Occlusions: The CART (Controlled Antegrade and Retrograde subintimal Tracking) Registry J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1135 - 1141. [Abstract] [Full Text] [PDF]

				K. Tsujita, A. Maehara, G. S. Mintz, T. Kubo, H. Doi, A. J. Lansky, G. W. Stone, J. W. Moses, M. B. Leon, and M. Ochiai Intravascular Ultrasound Comparison of the Retrograde Versus Antegrade Approach to Percutaneous Intervention for Chronic Total Coronary Occlusions J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 846 - 854. [Abstract] [Full Text] [PDF]

				S. Rathore, H. Matsuo, M. Terashima, Y. Kinoshita, M. Kimura, E. Tsuchikane, K. Nasu, M. Ehara, Y. Asakura, O. Katoh, et al. Procedural and In-Hospital Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions of Coronary Arteries 2002 to 2008: Impact of Novel Guidewire Techniques J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 489 - 497. [Abstract] [Full Text] [PDF]

				S. Rathore, O. Katoh, H. Matsuo, M. Terashima, N. Tanaka, Y. Kinoshita, M. Kimura, E. Tsuchikane, K. Nasu, M. Ehara, et al. Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries: Procedural Outcomes and Predictors of Success in Contemporary Practice Circ Cardiovasc Interv, April 1, 2009; 2(2): 124 - 132. [Abstract] [Full Text] [PDF]

				B. K. Courtney, N. R. Munce, K. J. Anderson, A. S. Thind, G. Leung, P. E. Radau, F. S. Foster, I. A. Vitkin, R. S. Schwartz, A. J. Dick, et al. Innovations in imaging for chronic total occlusions: a glimpse into the future of angiography's blind-spot Eur. Heart J., March 1, 2008; 29(5): 583 - 593. [Abstract] [Full Text] [PDF]

				D. Locca, C. Bucciarelli-Ducci, A. La Manna, and S. Prasad Percutaneous Coronary Intervention of Chronic Total Occlusion With Retrograde Approach: Follow-Up by Cardiac Magnetic Resonance Imaging Circulation, July 10, 2007; 116(2): e22 - e24. [Full Text] [PDF]

				K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter Percutaneous coronary intervention: recommendations for good practice and training Heart, December 1, 2005; 91(suppl_6): vi1 - vi27. [Abstract] [Full Text] [PDF]

				G. W. Stone, N. J. Reifart, I. Moussa, A. Hoye, D. A. Cox, A. Colombo, D. S. Baim, P. S. Teirstein, B. H. Strauss, M. Selmon, et al. Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part II Circulation, October 18, 2005; 112(16): 2530 - 2537. [Full Text] [PDF]

				A. E. Abbas, S. D. Brewington, S. R. Dixon, J. A. Boura, C. L. Grines, and W. W. O'Neill Intracoronary Fibrin-Specific Thrombolytic Infusion Facilitates Percutaneous Recanalization of Chronic Total Occlusion J. Am. Coll. Cardiol., September 6, 2005; 46(5): 793 - 798. [Abstract] [Full Text] [PDF]

				Z. Olivari, P. Rubartelli, F. Piscione, F. Ettori, A. Fontanelli, L. Salemme, C. Giachero, C. Di Mario, G. Gabrielli, L. Spedicato, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE) J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1672 - 1678. [Abstract] [Full Text] [PDF]

				L. Gruberg, R. Mehran, G. Dangas, M. K. Hong, G. S. Mintz, R. Kornowski, A. J. Lansky, K. M. Kent, A. D. Pichard, L. F. Satler, et al. Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions J. Am. Coll. Cardiol., January 1, 2000; 35(1): 151 - 156. [Abstract] [Full Text] [PDF]

				M. Hoher, J. Wohrle, O. C. Grebe, M. Kochs, H.-H. Osterhues, V. Hombach, and A. B. Buchwald A randomized trial of elective stenting after balloon recanalization of chronic total occlusions J. Am. Coll. Cardiol., September 1, 1999; 34(3): 722 - 729. [Abstract] [Full Text] [PDF]

				J Hancock, M R Thomas, S Holmberg, R J Wainwright, and D E Jewitt Randomised trial of elective stenting after successful percutaneous transluminal coronary angioplasty of occluded coronary arteries Heart, January 1, 1998; 79(1): 18 - 23. [Abstract] [Full Text] [PDF]