The collateral circulation of coronary chronic total occlusions

Margaret B. McEntegart, Athar A. Badar, Faheem A. Ahmad, Aadil Shaukat, Michael MacPherson, John Irving, Julian Strange, Alan J. Bagnall, Colm G. Hanratty, Simon J. Walsh, Gerald S. Werner, James C. Spratt

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    Abstract

    Aims: 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. 

    Methods and results: We studied the coronary angiograms of 481 patients with 519 CTOs at six centres in the UK 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.

    Original languageEnglish
    Article number310
    Pages (from-to)e1596-e1603
    Number of pages8
    JournalEuroIntervention
    Volume11
    Issue number14
    Early online dateApr 2016
    DOIs
    Publication statusPublished - Apr 2016

    Keywords

    • Angiography
    • Chronic total occlusion
    • Collateral circulation

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  • Cite this

    McEntegart, M. B., Badar, A. A., Ahmad, F. A., Shaukat, A., MacPherson, M., Irving, J., Strange, J., Bagnall, A. J., Hanratty, C. G., Walsh, S. J., Werner, G. S., & Spratt, J. C. (2016). The collateral circulation of coronary chronic total occlusions. EuroIntervention, 11(14), e1596-e1603. [310]. https://doi.org/10.4244/EIJV11I14A310