CTO PCI Complication — EECC MCQ

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HardCoronary Artery DiseaseCTO PCI ComplicationEECC

A 60-year-old man with stable angina and a chronic total occlusion (CTO) of the RCA with good collateral supply from the LAD undergoes CTO PCI. Despite successful wire crossing and balloon angioplasty, there is abrupt loss of flow in the collateral donor vessel (LAD). What is this complication called?

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Correct answer: E — Donor vessel compromise (collateral steal or injury)

During CTO PCI, the donor vessel (providing collateral flow to the CTO territory) can be compromised by haemodynamic shifts when antegrade flow is restored in the CTO vessel. This 'collateral steal' or donor vessel injury is a serious complication that can cause acute ischaemia in the territory previously supplied by the donor vessel. Additionally, collateral channels can be injured during retrograde wire crossing techniques. This is one of the reasons CTO PCI carries higher procedural risk than non-CTO PCI and should be performed by experienced operators. The 2024 ESC CCS Guidelines recommend CTO PCI only when performed by experienced operators and when symptoms/ischaemia warrant intervention.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes; EuroCTO Club Consensus