Use of a Novel Crossing and Re-Entry System in Coronary Chronic Total Occlusions That Have Failed Standard Crossing Techniques

Whitlow, Patrick L.; Burke, M. Nicholas; Lombardi, William; Wyman, R. Michael; Moses, Jeffrey W.; Brilakis, Emmanouil S.; Heuser, Richard R.; Rihal, Charanjit S.; Lansky, Alexandra J.; Thompson, Craig A.; Investigators, FAST-CTOs Trial

doi:10.1016/j.jcin.2012.01.014

Cited by 160 publications

(105 citation statements)

References 33 publications

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“…In the Evaluation of the XIENCE Coronary Stent, Performance, and Technique in Chronic Total Occlusions (EXPERT CTO) study, the incidence of PMI (defined as CK-MB !3Â ULN, similar to our study) was 10.8%, with retrograde techniques used in 20% of the study patients [10]. In the Facilitated Antegrade Steering Technique in Chronic Total Occlusions (FAST-CTOs) trial, 2.7% of patients had non-ST segment elevation MI, which was diagnosed if any total creatine kinase (CK) measurement was >2Â normal and the CK-MB level was elevated [11]; however, the percentage of patients who had CK-MB elevation !3Â ULN was not disclosed.…”

Section: Discussionsupporting

confidence: 76%

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Stetler¹,

Karatasakis

Christakopoulos

et al. 2016

Cathet Cardio Intervent

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Objectives: We sought to evaluate the impact of crossing strategy on the incidence of periprocedural myocardial infarction (PMI) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The optimal technique for crossing coronary CTOs remains controversial. Methods: We retrospectively examined the incidence of PMI among 184 consecutive patients who underwent CTO PCI at our institution between 2012 and 2015. Creatine kinase-myocardial band fraction (CK-MB) and troponin were measured before and after PCI in all patients. PMI was defined as CK-MB increase !33 upper limit of normal (ULN). Results: Mean age was 65 6 8 years, 98% of patients were men, 57% had diabetes mellitus, 36% were current smokers, 38% had prior heart failure, 31% had prior coronary artery bypass graft surgery (CABG), and 55% had prior PCI. The retrograde approach was used in 38% of cases. As compared with antegrade wire escalation and antegrade dissection/re-entry, use of the retrograde approach was associated with higher J-CTO (Multicenter CTO Registry of Japan) scores (P < 0.0001), higher frequency of moderate or severe calcification (P 5 0.0061), longer CTO length (P < 0.0001), more frequent proximal cap ambiguity (P < 0.0001), and lower technical (P 5 0.0007) and procedural (P 5 0.0014) success. The frequency of PMI for the antegrade-only and retrograde cases was 10% and 33%, respectively (P 5 0.0001). On multivariate analysis, use of the retrograde approach and moderate/severe calcification were independently associated with higher incidence of PMI. Conclusions: As compared with antegrade-only crossing techniques, the retrograde approach is used in patients with more complex anatomy but may carry higher risk for PMI. V C 2016 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 76%

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Stetler¹,

Karatasakis

Christakopoulos

et al. 2016

Cathet Cardio Intervent

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“…Second-generation forwardlooking IVUS is currently under investigation. Here, the catheter is integrated with a radiofrequency [20]. In their experiences of CTOs untreatable using standard techniques, this novel system yielded a high success rate without increasing complications.…”

Section: Clinical Implication and Future Directionsmentioning

confidence: 99%

Japanese multicenter registry evaluating the retrograde approach for chronic coronary total occlusion

Tsuchikane

Yamane²,

Murata

et al. 2013

Cathet Cardio Intervent

100

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“…In the multicentre Facilitated Steering Technique in Chronic Total Occlusions (FAST-CTOs) study [13], the BridgePoint was used in 147 patients with CTO resistant to previous Long-term outcomes of coronary artery stent implantation within the subintimal space were initially a very controversial issue. This was particularly the case with methods associated with extensive and uncontrolled dissection, as in the procedures involving STAR and miniSTAR techniques.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous recanalisation of chronically occluded coronary arteries with the CrossBoss/Stingray system: first experience (report of three cases)

Drozd¹,

Strange

Wysokińska

et al. 2015

Kardiol Pol

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A b s t r a c tBackground and aim: Percutaneous coronary interventions (PCI) within chronically occluded coronary arteries remain challenging procedures with a lower success rate compared to classic PCI. However, over the last years we have witnessed many technological advances in the treatment of chronic total occlusion (CTO) including new wires, retrograde approach, subintimal tracking and re-entry technique, all underlying which the current success rate of up to 95% in dedicated centres. Subintimal space wire penetration is no longer a problem that would require terminating the procedure. It is now a desired part of hybrid CTO approach involving both antegrade and retrograde crossing and re-entry. The new device which facilitates controlled dissection and true lumen re-entry is the Boston Scientific Coronary CTO Crossing System consisting of a CrossBoss microcatheter and Stingray balloon and dedicated wire. Methods: On October 29th and 30 th , 2014, percutaneous coronary recanalisation using the CrossBoss/Stingray system was performed in 3 men aged 63-75, with symptoms of stable CCS class II/III angina, without prior myocardial infarction in the area of CTO artery supply and with preserved myocardial contractility. Each patient underwent at least one previous unsuccesful antegrade/retrograde CTO recanalisation procedure. The J-CTO score was 3-4. Results:The procedure was successful in all 3 patients: 2 right coronary arteries and 1 left anterior descending artery were opened. In all 3 cases, both the CrossBoss catheter and the Stingray re-entry system were used. Two to three drug eluting stents were implanted in each patient, with the total length of 62-106 mm and final TIMI 3 flow. The mean procedure time was 141 min (130-150 min), mean fluoroscopy time was 53 min (48-56 min), absorbed dose was 4772 mGy (4098-5633 mGy), dose area product was 565,208 cGy × cm 2 (535,109-590,266 cGy × cm 2 ), and the mean contrast volume was 343 mL (320-350 mL). No procedure-related complications were note except for an asymptomatic increase in high-sensitivity troponin T level up to 157 ng/mL (reference range 0-14 ng/mL) in 1 patient. Conclusions:The Boston Scientific Coronary CTO Crossing System is a useful device for percutaneous recanalisation of chronically occluded coronary arteries. It helps to achieve procedural success in more complex cases within relatively short crossing times and with a limited amount of the contrast agent and X-ray dose.

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Use of a Novel Crossing and Re-Entry System in Coronary Chronic Total Occlusions That Have Failed Standard Crossing Techniques

Abstract: In CTOs failing standard techniques, use of a new crossing and re-entry system results in a high success rate without increasing complications.

Cited by 160 publications

References 33 publications

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Japanese multicenter registry evaluating the retrograde approach for chronic coronary total occlusion

Percutaneous recanalisation of chronically occluded coronary arteries with the CrossBoss/Stingray system: first experience (report of three cases)

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