Developments in Coronary Chronic Total Occlusion PCIs
Developments in Coronary Chronic Total Occlusion PCIs
Wilson et al reported 87% technical success (27 of 31 cases) in CTOs due to in-stent restenosis using the CrossBoss catheter (Boston Scientific); the CrossBoss catheter crossed into the distal true lumen in most cases. The blunt tip of the CrossBoss catheter can often prevent wire passage outside stent struts, facilitating CTO crossing.
Although the Stingray balloon (Boston Scientific) is considered to require a guide catheter at least 6 Fr in diameter, Wu and Ikari reported for the first time successful CTO PCI through a 5 Fr Ikari left 3.5 transradial guide catheter. Takahashi et al reported 2 cases in which an IVUS catheter was inserted into the cardiac vein parallel to the target artery to facilitate antegrade wire crossing (Figure 1).
(Enlarge Image)
Figure 1.
(A) Chronic total occlusion of the middle left circumflex artery (LCX) (solid arrow) before transvenous intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). (B) Final angiography after transvenous IVUS-guided PCI. (C) Angiographic image obtained during transvenous IVUS-guided PCI. The solid arrow indicates a guidewire in the occluded site of the LCX. The dashed arrow indicates an IVUS catheter in the cardiac vein, with (D) corresponding IVUS image. A guidewire can be seen in the center of the occluded site of the LCX (solid arrow). The dashed arrow indicates an IVUS catheter in the cardiac vein. Reproduced with permission from HMP Communications.
Valenti et al reported reocclusion in 16 of 28 patients in whom CTO recanalization was achieved using the Subintimal Tracking and Reentry (STAR) technique. Given these poor long-term outcomes, the STAR technique should only be used as a "last resort," after failure of other techniques and devices to cross the CTO.
Godino et al reported a case of residual long coronary dissection left unstented after guided STAR in a right coronary artery that had resolved at 2-month follow-up exam, suggesting that sometimes conservative management may be appropriate in areas of coronary dissection, especially if Thrombolysis in Myocardial Infarction (TIMI)-3 flow is present in spite of the dissection and if the dissection persists into distal branches.
Mogabgab et al reported the short- and long-term outcomes in patients in whom the CrossBoss catheter and Stingray system (Boston Scientific) were used (n = 60) and compared them to patients treated with other techniques (n = 110). During a median follow-up of 1.81 years, the CrossBoss/Stingray group had no difference in target lesion revascularization (40.9% vs 29.6%; P=.13) or major adverse clinical events (40.3% vs 35.2%; P=.42) in spite of its use in higher complexity cases.
Antegrade Dissection and Reentry
Wilson et al reported 87% technical success (27 of 31 cases) in CTOs due to in-stent restenosis using the CrossBoss catheter (Boston Scientific); the CrossBoss catheter crossed into the distal true lumen in most cases. The blunt tip of the CrossBoss catheter can often prevent wire passage outside stent struts, facilitating CTO crossing.
Although the Stingray balloon (Boston Scientific) is considered to require a guide catheter at least 6 Fr in diameter, Wu and Ikari reported for the first time successful CTO PCI through a 5 Fr Ikari left 3.5 transradial guide catheter. Takahashi et al reported 2 cases in which an IVUS catheter was inserted into the cardiac vein parallel to the target artery to facilitate antegrade wire crossing (Figure 1).
(Enlarge Image)
Figure 1.
(A) Chronic total occlusion of the middle left circumflex artery (LCX) (solid arrow) before transvenous intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). (B) Final angiography after transvenous IVUS-guided PCI. (C) Angiographic image obtained during transvenous IVUS-guided PCI. The solid arrow indicates a guidewire in the occluded site of the LCX. The dashed arrow indicates an IVUS catheter in the cardiac vein, with (D) corresponding IVUS image. A guidewire can be seen in the center of the occluded site of the LCX (solid arrow). The dashed arrow indicates an IVUS catheter in the cardiac vein. Reproduced with permission from HMP Communications.
Valenti et al reported reocclusion in 16 of 28 patients in whom CTO recanalization was achieved using the Subintimal Tracking and Reentry (STAR) technique. Given these poor long-term outcomes, the STAR technique should only be used as a "last resort," after failure of other techniques and devices to cross the CTO.
Godino et al reported a case of residual long coronary dissection left unstented after guided STAR in a right coronary artery that had resolved at 2-month follow-up exam, suggesting that sometimes conservative management may be appropriate in areas of coronary dissection, especially if Thrombolysis in Myocardial Infarction (TIMI)-3 flow is present in spite of the dissection and if the dissection persists into distal branches.
Mogabgab et al reported the short- and long-term outcomes in patients in whom the CrossBoss catheter and Stingray system (Boston Scientific) were used (n = 60) and compared them to patients treated with other techniques (n = 110). During a median follow-up of 1.81 years, the CrossBoss/Stingray group had no difference in target lesion revascularization (40.9% vs 29.6%; P=.13) or major adverse clinical events (40.3% vs 35.2%; P=.42) in spite of its use in higher complexity cases.
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