ArticleQuantitative imaging in medicine and surgery2026
The incremental value of invasive coronary angiographic characteristics in predicting the success of retrograde chronic total occlusion percutaneous coronary intervention via invisible collateral channels.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the Guidezilla catheter (Boston Scientific) via invisible septal collateral channels (CCs) has not been extensively investigated. This study aimed to evaluate the incremental value of invasive coronary angiography (ICA) characteristics combined with the Guidezilla catheter for predicting technical success during retrograde CTO PCI through invisible septal CCs. Methods: We analyzed 166 consecutive retrograde CTO PCI procedures performed via invisible septal CCs (with or without the Guidezilla catheter) across 40 centers from January 2019 to December 2022. Clinical, ICA, and procedural characteristics, along with outcomes, were assessed. Logistic regression analysis was performed to identify technical success predictors, while the discriminatory power of the multivariate model was evaluated via receiver operator characteristic (ROC) curves. Results: The overall technical success rate for CTO PCI via invisible septal CCs was 81.33%. Multivariate analysis identified the following characteristics as independent and significant predictors of technical success via invisible septal CCs: a ratio of the right coronary artery-posterior descending artery length (RCA-PDA length) to the length of the PDA origin to the apex (LOPA) greater than 0.64 [hazard ratio (HR) =6.19, 95% confidence interval (CI): 2.55-14.99; P<0.001] and the use of the Guidezilla catheter (HR =2.42; 95% CI: 1.01-5.79; P=0.048). The combination of RCA-PDA length:LOPA ratio and Guidezilla status demonstrated superior predictive capability [areas under the ROC curve (AUC) =0.74; 95% CI: 0.67-0.81] compared to the Guidezilla-only model (AUC =0.62; 95% CI: 0.54-0.69; P=0.017). Conclusions: Incorporating the ICA characteristic of the RCA-PDA length:LOPA ratio significantly improved predictive accuracy when compared to the use of Guidezilla catheter status alone. Thus, ICA characteristics provide significant incremental value in predicting technical success when the Guidezilla catheter is applied for retrograde CTO PCI via invisible septal CCs.
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