Aims: Septal surfing and distal tip injections are two techniques used for septal crossing in retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI). The aim of this study was to examine for the first time the safety and feasibility of the septal surfing technique.
Methods and results: Among 470 consecutive CTO PCIs performed in the Quebec hybrid CTO PCI program between January 2010 and December 2015, 240 (51%) involved a retrograde attempt. In the septal crossing subgroup, we evaluated whether the Werner collateral channel (CC) classification, CTO location, tortuosity, and number of large septal CCs influenced retrograde crossing success, time, and perforation. Septal channels were used in the majority (n=152, 63%) of cases. Patients in the septal subgroup were younger, had less bypass surgery, were more likely to have RCA CTO and had previous failure. Septal channels were successfully crossed with the wire using the surfing technique in 81%, irrespective of the CC size. Septal crossing success and time were not influenced by Werner CC class but by septal CC tortuosity. One quarter of cases had septal perforations; all were minor and asymptomatic.
Conclusions: Septal surfing is a safe and highly successful technique for crossing septal CCs when a retrograde approach is mandated for CTO PCI. The Werner class does not affect retrograde CC crossing success or time.