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The collateral circulation of coronary chronic total occlusions

Lookup NU author(s): Dr Alan Bagnall


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© Europa Digital & Publishing 2016. All rights reserved. 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.

Publication metadata

Author(s): McEntegart MB, Badar AA, Ahmad FA, Shaukat A, MacPherson M, Irving J, Strange J, Bagnall AJ, Hanratty CG, Walsh SJ, Werner GS, Spratt JC

Publication type: Article

Publication status: Published

Journal: EuroIntervention

Year: 2016

Volume: 11

Issue: 14

Pages: e1596-e1603

Online publication date: 08/04/2016

Acceptance date: 01/01/1900

ISSN (print): 1774-024X

ISSN (electronic): 1969-6213

Publisher: EuroPCR


DOI: 10.4244/EIJV11I14A310


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