Novel ``crowbar effect'' approach to improve success rate of recanalization of coronary chronic total occlusions

Abstract

To explore the key points of a novel "crowbar effect" approach to improve the success rate of recanalization of CTOs. METHODS: One hundred and fifty-seven patients with CTO were treated with PCI using the regular antegrade guide wire approach. Of them, 36 patients (22.9%) showed that while the first guide wire was inserted into the CTO lesions, a small balloon had difficulty passing through the CTO lesions. For those patients, the new crowbar effect technique was used to allow the balloon to pass through the lesions. RESULTS:The coronary CTO vessels in 35 patients (97.2%) were completely opened. Coronary perforation occurred in 5 patients (13.8%). This perforation was properly treated and did not lead to serious complications. CONCLUSION: The crowbar effect technique proved successful as an alternative antegrade method for opening CTO. The procedure of this novel method is easy to accomplish and success rates are high.Keywords: Coronary artery, chronic total occlusion, percutaneous coronary intervention, crowbar effect technique, success rate [1] IntroductionCoronary chronic total occlusion (CTO) lesions refer to coronary artery occlusions that are present for at least three months. The benefits of CTO recanalization include symptom relief, improved regional and global left ventricular function, improved quality of life, and better long-term survival rate versus failed recanalization CTO treatments with percutaneous coronary intervention (PCI) [1][2][3]. Successful revascularization may improve angina, increase exercise capacity, reduce the possibility of the late coronary artery bypass graft (CABG) surgery [4], and improve quality of life. CTO lesions are typically complex, and associated with atheromatous plaque, thrombosis, and fiber endangium proliferation. The recanalization of CTO lesions is one of the most challenging PCI procedures [4][5][6] and has been called "the last frontier" of PCI. The primary reasons for this are associated with the technical complexity, poor * Corresponding author: Tongku Liu, Affiliated Hospital of Beihua University, Jilin, Jilin, China. E-mail: liutongku2010 @163.com.

An algorithmic approach to balloon‐uncrossable coronary lesions

“…The created channel is inflated further with the balloon and stenting is performed. Liu et al 17 reported successful application of this technique in 35 of 36 patients with balloon uncrossable CTOs (97.2%).…”