Chronic total occlusion anatomy and characteristics of coronary collaterals and angiographic features predicting the success of chronic total occlusion intervention

Abstract EN

Background and objective : angiographic assessment of chronic total occlusion (CTO) anatomy and collateral characteristics of coronary arteries are necessary for CTO intervention.

materials and methods : this was a hospital-based observational study of 100 coronary angiograms (CAG) with CTOs.

CTO anatomy and collateral characteristics of coronary arteries were studied for predicting anterograde and retrograde CTO intervention.

Results : right coronary artery (RCA) CTO was the most common (62%), followed by left anterior descending (LAD).

more than two-thirds of RCA and LAD CTO lesions were >20 mm and half were in mid-segment.

left circumflex artery (LCX) and RCA lesions were more frequently calcified.

LAD CTOs often had blunt stump ; LCX CTOs frequently had bending >45°.

the mean J-CTO score was lowest in RCA CTOs (2.0 ± 1.19).

there were 10 different types of collaterals in RCA CTOs, 8 in LAD CTOs, and only 4 in LCX CTOs.

the most common RCA CTOs collateral was LAD septal to the right posterior descending artery (RPDA) (69.4%) and in LAD CTOs, the most common was septal collaterals from the RPDA to LAD (40.9%).

RCA CTOs had a higher percentage of septal collaterals, less tortuosity, and favorable entry and exit angle when compared with other two arteries.

Conclusion : RCA CTOs were the most common.

angiographic features in CTO lesions vary among three major coronary arteries.

the RCA CTOs had lesser mean J-CTO score, more number of septal collaterals, less tortuous collaterals, and favorable entry and exit angle.

RCA CTOs were better accessible for anterograde and retrograde intervention.