Intraluminal blunt microdissection for angioplasty of coronary chronic total occlusions

Abstract

This study describes a new approach to crossing coronary chronic total occlusions using controlled blunt microdissection and its successful application to coronary angioplasty in three patients. After guidewire techniques failed to cross the occlusions, the blunt intraluminal microdissection catheter was deployed. Actuation of a hinged jaw on the catheter distal assembly created a channel for the guidewire through the diseased segment, in the true lumen (a right coronary and a left circumflex artery) and subintimally (a circumflex artery), to allow angioplasty and stenting. Coronary circulation improved from TIMI grade 0 to 3. Angina was relieved in all three cases. Subsequent angiography for two cases, 2 and 19 months after PTCA, respectively, showed restored flow and patent stented regions.

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

“…The Frontrunner Catheter (Lumend) is a manually operated device incorporating a bilaterally hinged distal tip assembly that, when activated, spreads tissue planes via the principle of blunt microdissection. 46 The device is supported by a probing and recanalization catheter (the 4.5F Micro Guide Catheter) as it is passed across the occlusion. The current X-39 Frontrunner has an outer diameter of 0.03 to 0.04 inches, with a 2.8F distal tip.…”

High‐frequency vibration for the recanalization of guidewire refractory chronic total coronary occlusions

“…The FrontRunner Catheter (Cordis Endovascular, Warren, NJ) contains a 0.039'' cable that connects to two blunt jaws located at the tip creating channels by blunt microdissection into and through the occluded segment [25]. Although the FrontRunner catheter was successful in 56% of cases, there were device-related perforations found in 2 (1.9%) patients.…”

Successful use of the frontrunner catheter in the treatment of in‐stent coronary chronic total occlusions

“…As the Frontrunner device is believed to cause preferential disruption of plaque because of the difference in elastance between the plaque and the adventitia, it sometimes creates extraluminal passages along subintimal planes in de novo CTOs [8,9]. Although successful subintimal angioplasty and stenting have previously been achieved, the passage of guidewire into the subintima reduces procedure success rate and may lead to vascular complications [10,11].…”

“…Blunt microdissection, the concept underlying the Frontrunner device, takes advantage of the differential elastance between intraluminal plaque and the adventitia and leads to preferential disruption of the fibrocalcific plaque while maintaining the integrity of the outer layer of the arterial wall. Preliminary experience with the device proves its usefulness in crossing total occlusions resistant to conventional guidewires with a fairly acceptable safety profile characterized by a low perforation rate [8,9]. The current generation of the device, the Frontrunner X39 CTO catheter, is a sin-gle-use 3.1 Fr catheter with a straight but shapeable distal jaw tip that opens to a maximal diameter of 2.3 mm.…”