A Chinese scoring system for predicting successful retrograde collateral traverse in patients with chronic total coronary occlusion

Figures

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  Fig. 1. Study protocol and definition: a Total 9841 patients received PCI treatment in our institution. 1508 total patients with chronic total occlusion (CTO) were treated by percutaneous coronary intervention (PCI). Of these patients, 309 total patients underwent retrograde PCI for CTO recanalization (1199 patients were treated via antegrade approach only). They were divided into a training cohort (208 patients with 348 collateral channels) and a validation cohort (101 patients with 115 collateral channels); b An effective attempt was defined as the guide wire tip traveling over 4/5th the distance from donor to recipient vessels; c Connections between collateral channels and recipient vessels; and d Angle between collateral channels and donor (or recipient) vessels

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  Fig. 2. Procedural techniques and population characteristic in the training cohort: The collateral circulation was successfully traversed by both guide wires and catheters in 102 cases. Successful intervention was achieved via retrograde approach without any complications in 78 cases

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  Fig. 3. Area under the curve among CC grades, Rentrop grades, and the connections between collateral channels and recipient vessels

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  Fig. 4. Nomogram and its efficiency: a A nomogram predictive scoring system for successful retrograde collateral channel traverse: age (21 point), connection between collateral channels and recipient vessels and collateral tortuosity (100 point), and channel tortuosity (19 points); b Scoring system verification: ROC of training cohort; c ROC of validation cohort; d The calibration curve in training cohort; and e The calibration curve in validation cohort; f The success rate in Easy, Middle, and Hard group, showing the significant discrimination; g The workflow for quick evaluation in clinical practice; h The interface of the ACT scoring system software

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  Fig. 5. Our recommendation for retrograde collateral circulation traverse approach: a The steps for retrograde collateral circulation traverse; b and c The original angiographic pictures of collateral selection. Orange circle indicated connection between collateral and recipient vessels; white arrows pointed to the selected channels