Temporal trends in retrograde crossing of epicardial collaterals in chronic total occlusion percutaneous coronary intervention

Authors

• Theodoros Vichos
• Dimitrios Strepkos
• Michaella Alexandrou
• Pedro E P Carvalho
• Ayman Fath
• Mishita Goel
• Lorenzo Azzalini
• Khaldoon Alaswad, Henry Ford HealthFollow
• Mir B. Basir, Henry Ford HealthFollow
• Dmitrii Khelimskii
• Oleg Krestyaninov
• Jaikirshan J Khatri
• Laura Young
• Paul Poommipanit
• Omer Goktekin
• Farouc Jaffer
• Sevket Gorgulu
• Ahmed M ElGuindy
• Nidal Abi Rafeh
• Sai S Narla
• Olga Mastrodemos
• Bavana V Rangan
• Noah N Williford
• Yader Sandoval
• Emmanouil S Brilakis

Recommended Citation

Vichos T, Strepkos D, Alexandrou M, Carvalho PEP, Fath A, Goel M, Azzalini L, Alaswad K, Basir MB, Khelimskii D, Krestyaninov O, Khatri JJ, Young L, Poommipanit P, Goktekin O, Jaffer F, Gorgulu S, ElGuindy AM, Rafeh NA, Narla SS, Mastrodemos O, Rangan BV, Williford NN, Sandoval Y, Brilakis ES. Temporal trends in retrograde crossing of epicardial collaterals in chronic total occlusion percutaneous coronary intervention. Int J Cardiol. 2026;459:134586.

Document Type

Article

Publication Date

9-15-2026

Publication Title

International journal of cardiology

Keywords

Humans, Male, Coronary Occlusion, Percutaneous Coronary Intervention, Registries, Female, Collateral Circulation, Aged, Chronic Disease, Pericardium, Middle Aged, Time Factors, Treatment Outcome

Abstract

BACKGROUND: Epicardial collaterals represent a conduit for retrograde crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but carry higher procedural risk compared with septal or bypass graft crossing.

METHODS: We analyzed 1527 CTO PCI cases attempted via epicardial collaterals between January 2012 and March 2026 from the PROGRESS-CTO multicenter registry (49 centers). Temporal trends were assessed using logistic regression. Technical success, procedural success, and in-hospital major adverse cardiac events (MACE) were evaluated.

RESULTS: Mean patient age was 65 ± 10 years; 86.4% were men. Lesion complexity was high (mean J-CTO score 3.16 ± 1.02). Use of the retrograde approach overall and via epicardial collaterals decreased significantly over time (both p <  0.001). Epicardial collateral crossing success increased (p <  0.001), while MACE rates did not change significantly (p = 0.085). Technical and procedural success were 77.0% and 74.4%, respectively. In-hospital MACE occurred in 3.8% of cases. Coronary perforation occurred in 13.8% of procedures and was strongly associated with MACE (15.2% vs. 2.0%, p <  0.001).

CONCLUSIONS: In a large contemporary multicenter registry, while use of retrograde CTO PCI via epicardial collaterals declined over time, crossing success improved without a significant increase in complications, suggesting improved case selection and procedural expertise.

Medical Subject Headings

Humans; Male; Coronary Occlusion; Percutaneous Coronary Intervention; Registries; Female; Collateral Circulation; Aged; Chronic Disease; Pericardium; Middle Aged; Time Factors; Treatment Outcome

PubMed ID

42203005

Volume

459

First Page

134586

Last Page

134586