Key result
Epicardial collateral use in retrograde CTO PCI linked to ~5.6-fold higher pericardial effusion risk.
Why the study?
Septal collateral channels are generally preferred for retrograde CTO PCI due to the risk of hemopericardium and cardiac tamponade with epicardial collateral channel injury, yet comparative evidence on procedural safety and long-term clinical outcomes between epicardial and septal collateral channel use remained limited.
Does retrograde CTO PCI via an epicardial collateral channel affect procedural safety (periprocedural pericardial effusion) and long-term major adverse cardiovascular events compared to a septal collateral channel in patients undergoing elective retrograde CTO PCI?
Cohort (n=750)
Does retrograde CTO PCI via an epicardial collateral channel affect procedural safety (periprocedural pericardial effusion) and long-term major adverse cardiovascular events compared to a septal collateral channel in patients undergoing elective retrograde CTO PCI?
In retrograde CTO PCI, using epicardial collateral channels significantly increases the risk of periprocedural pericardial effusion and need for pericardiocentesis compared to septal channels, although technical success and long-term MACE rates appear comparable.
Answers are grounded in this paper and cite their sources.
Epicardial CC warrants effusion vigilance; Level 5 data leave open causality and net benefit.
Background: Septal collateral channels (CCs) are generally preferred for retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) because epicardial CC injury may result in hemopericardium and cardiac tamponade. However, comparative evidence on the procedural safety and long-term clinical outcomes of epicardial versus septal CC use remains limited. Methods: We retrospectively analyzed 750 patients who underwent elective retrograde CTO PCI from January 2011 through April 2023. The primary procedural safety outcome was periprocedural pericardial effusion. The primary long-term outcome was major adverse cardiovascular events (MACEs), defined as all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Multivariable logistic and Cox regression models were used to evaluate these outcomes. Results: 544 patients underwent retrograde CTO PCI through a septal CC and 206 through an epicardial CC. Pericardial effusion (7.3% vs. 1.7%; p < 0.001) and pericardiocentesis (5.3% vs. 1.1%; p = 0.001) were more frequent with epicardial CC use. CC wire crossing success (90.8% vs. 94.5%; p = 0.067), retrograde technical success (87.9% vs. 90.1%; p = 0.40), and overall recanalization success (90.3% vs. 91.0%; p = 0.80) did not differ significantly. Epicardial CC use was associated with higher odds of pericardial effusion (OR 5.60, 95% CI 2.26–14.70, p < 0.001). During a median follow-up of 1039 days, MACE occurred in 15.0% and 16.5% of the epicardial and septal CC groups, respectively (HR 1.10, 95% CI 0.71–1.70, p = 0.659). Conclusions: Epicardial CC use was associated with more periprocedural pericardial effusion than septal CC use. No statistically significant differences in technical success or long-term MACE were detected; these findings do not establish equivalence and are subject to anatomical selection and residual confounding.
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Huang et al. (2026) conducted a cohort in Chronic total occlusion (n=750). Epicardial collateral channel use in retrograde CTO PCI vs. Septal collateral channel use in retrograde CTO PCI was evaluated on Periprocedural pericardial effusion (primary procedural safety outcome) and major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization; primary long-term outcome) (OR 5.60, 95% CI 2.26-14.70, p=<0.001). Epicardial vs septal collateral use in retrograde CTO PCI increased pericardial effusion (7.3% vs 1.7%; OR 5.60, 95% CI 2.26-14.70) without affecting long-term MACE (HR 1.10; p=0.659).
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