Blunt Microdissection for Endovascular Treatment of Infrainguinal Chronic Total Occlusions

Abstract

The CrossBoss blunt microdissection catheter facilitated successful crossing of CTOs in patients with infrainguinal lesions following unsuccessful guidewire crossing, with an acceptably low rate of periprocedural complications and significant improvement in symptoms.

Femoropopliteal Artery Stent Thrombosis

“…14 Occurrence of ST was determined by acute onset of lower extremity pain in the form of claudication or acute limb ischemia and angiographic evidence of thrombus. The XL PAD criterion for establishing the diagnosis of ST was formulated by the study executive committee, based on ‘event certainty’ and the ‘time frame’.…”

Comparative Assessment of Guidewire and Microcatheter vs a Crossing Device–Based Strategy to Traverse Infrainguinal Peripheral Artery Chronic Total Occlusions

“…Vascular calcification visible on angiographic views prior to contrast injection was classified as mild (isolated foci of calcification), moderate (contiguous segments of calcification on one or alternating sides of the vessel), or severe (contiguous calcification on both sides of the vessel). [7][8][9][10] …”

“…Technical descriptions of these approved devices have previously been published. 7,8,11 Endpoints and Definitions Outcome measures included crossing success, procedure success, complications, and major adverse events (MAEs). Crossing success was defined as placement of a guidewire in the distal true lumen, past the distal CTO cap, confirmed by either angiography or intravascular ultrasound (IVUS).…”

“…Given these challenges, a crossing device must be firm to penetrate the proximal cap, highly maneuverable to allow directional guidance, and flexible, with a low profile to avoid large dissections or perforation. [6][7][8] Successful crossing of infrainguinal CTOs involves selection of an optimal initial crossing strategy, which can be broadly divided into 2 groups: use of a guidewire supported by a microcatheter (wire-catheter strategy) or use of a specialized CTO crossing device. However, there are to date no comparative clinical studies to guide decision making between these crossing strategies.…”

“…Given these challenges, a crossing device must be firm to penetrate the proximal cap, highly maneuverable to allow directional guidance, and flexible, with a low profile to avoid large dissections or perforation. 6–8…”