1
|
Therasse E, Benko A, Brodmann M, Hadziomerovic A. A Multinational, Single-Arm Pivotal Study Assessing the Performance of the SoundBite Crossing System for Peripheral Chronic Total Occlusions (The PROSPECTOR Study). J Vasc Interv Radiol 2021; 33:50-59. [PMID: 34628039 DOI: 10.1016/j.jvir.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/08/2021] [Accepted: 07/10/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This study aimed to demonstrate the efficacy and safety of the SoundBite Crossing System‒Peripheral (SCS-P) to facilitate crossing chronic total occlusions (CTOs) of infrainguinal arteries. MATERIALS AND METHODS This clinical trial was approved by the Ethics Committees of all 4 participating centers and enrolled 52 patients with symptomatic de novo infrainguinal CTOs. Technical device success, the primary efficacy endpoint, was defined as the ability to facilitate the treatment of the target lesion by crossing a portion or the whole length of the CTO. Freedom from SCS-P-related major adverse events (MAEs) at 30 days after the procedure was the primary safety endpoint. RESULTS The SCS-P met the primary efficacy and safety endpoints in 92.3% (48/52) and 100% (52/52) of subjects, respectively. Technical device success with postprocedural patency and freedom from SCS-P-related MAEs was achieved in 88.5% (46/52) of subjects. The mean CTO crossing time was 20.0 minutes ± 30.8, and the SCS-P was able to traverse the whole CTO and enter the distal true lumen without the need of any other device in 59.6% (31/52) of subjects. The mean Rutherford category and ankle-brachial index improvement at the 30-day follow-up was 2.4 ± 1.17 and 0.23 ± 0.22, respectively. CONCLUSIONS The SCS-P demonstrated a satisfactory safety and performance profile to cross peripheral CTOs and enter the distal true lumen of infrainguinal CTOs.
Collapse
Affiliation(s)
- Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Andrew Benko
- Department of Radiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Adnan Hadziomerovic
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Nishimoto Y, Fukuhara R, Toma M, Sato Y. A novel technique: passing through bulky calcified nodules projecting into a popliteal artery using a TruePath crossing device: A novel CanPath technique. ASIAINTERVENTION 2020; 6:104-105. [PMID: 34912995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/04/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Rei Fukuhara
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| |
Collapse
|
3
|
Laird JR, Mathews SJ, Brodmann M, Soukas PA, Schmidt A. Performance of the Wingman catheter in peripheral artery chronic total occlusions: Short-term results from the international Wing-It trial. Catheter Cardiovasc Interv 2020; 97:310-316. [PMID: 33211386 PMCID: PMC7984280 DOI: 10.1002/ccd.29366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the safety and effectiveness of a peripheral artery chronic total occlusion (CTO) crossing catheter following failed crossing attempts with standard guidewires. BACKGROUND CTO crossing remains a challenge during peripheral artery interventions. METHODS In this prospective, international, single-arm study, patients with a peripheral artery CTO that was uncrossable with standard guidewires were treated with a crossing catheter (Wingman, Reflow Medical). The primary efficacy endpoint of CTO crossing success was compared to a performance goal of 70.7%. The primary composite safety endpoint (major adverse event [MAE], clinically significant perforation or embolization, or grade C or greater dissection) was assessed over a 30-day follow-up period and compared to a performance goal of 13.0%. RESULTS A total of 85 patients were treated using the Wingman catheter for peripheral artery CTO crossing. Key patient characteristics were mean age of 71±9 years, 66% male, and mean lesion length of 188±94 mm in the superficial femoral artery (71%), popliteal artery (15%), or infrapopliteal arteries (14%). Both primary endpoints of the trial were met¾CTO crossing success was 90% (lower confidence limit=82.5%) and 5 primary safety events occurred in 4 (4.8%) patients (upper confidence limit=10.7%). Over 30 days of follow-up, Rutherford score decreased by at least 2 categories in 74% patients; the percentage of patients with normal hemodynamics assessed with the ankle-brachial index increased from 1% to 51%. CONCLUSIONS Among patients with a CTO that was unable to be crossed with a standard guidewire, the Wingman catheter was able to cross 90% of occlusions with a favorable safety profile.
Collapse
Affiliation(s)
- John R Laird
- Adventist Heart and Vascular Institute, Adventist St. Helena Hospital, St. Helena, California
| | | | | | - Peter A Soukas
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island
| | - Andrej Schmidt
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
| | | |
Collapse
|
4
|
IVUS Assessment of the Crossing Pathway of an Intraluminal Reentry Device Used in the Primary Treatment of Infrainguinal Chronic Total Occlusions. J Endovasc Ther 2019; 27:69-76. [DOI: 10.1177/1526602819884054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To examine with intravascular ultrasound (IVUS) the crossing pathways of the TruePath reentry device during primary antegrade recanalization of infrainguinal chronic total occlusions (CTOs). Methods: Between July 2017 and September 2018, a prospective multicenter study enrolled 143 consecutive patients (mean age 75±9 years; 101 men) with 146 CTOs treated in an antegrade approach using the TruePath reentry device with IVUS assessment of the crossing pathway in successful cases. Outcome measures were complete success (reentry device reached the distal true lumen), assisted success (reentry device use followed by a conventional guidewire to reach the distal true lumen), reentry device crossing route by IVUS assessment, and procedure- and device-related complications. Regression analyses were employed to identify any relevant associations between baseline patient variables and the outcome measures; results are presented as the odds ratio (ORs) and 95% confidence interval (CI). Results: Complete success was achieved in 82 (56.2%) lesions; any success (complete plus assisted) was documented in 117 (80.1%) lesions. Four (3%) perioperative device-related complications were observed. The crossing route was intraplaque for most of the total crossing distance in both complete success cases (95.3%±13.2%) and any success cases (94.8%±14.4%), with relatively short subintimal (3.6%±10.2% and 4.2%±11.2%, respectively) or intramedial (1.2%±5.8% and 1.0%±5.4%, respectively) crossing. CTO length was a significant risk factor for not achieving complete success (OR 1.74, 95% CI 1.13 to 2.68, p=0.012), and a history of failed revascularization was associated with not achieving any success (OR 6.40, 95% CI 1.28 to 28.9, p=0.038). Conclusion: The intraplaque route was the primary pathway taken by the TruePath reentry device as it crossed infrainguinal CTOs. Crossing rates were acceptable, with few device-related complications. However, a longer CTO length and a failed revascularization history negatively affected the success rate.
Collapse
|
5
|
Cunier M, Najafi A, Sheikh GT, Binkert CA. Alternative crossing technique for iliaco-femoro-popliteal CTOs with a catheter only. CVIR Endovasc 2019; 2:23. [PMID: 32026995 PMCID: PMC6966370 DOI: 10.1186/s42155-019-0065-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/09/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The standard approach for crossing peripheral CTOs is to use a combination of hydrophilic guidewires and catheters. The path is either intraluminally or in most cases at least partially subintimal. This standard approach with a guidewire-tip as leading point ("wire first") to cross CTOs has a success rate of about 80%. We hypothesize that a "catheter first" approach, using the catheter alone for the entire recanalization till re-entering the vessel is less traumatic and might lead to a longer intraluminal recanalization due to a softer leading point. Based on this assumption we analyzed the success and duration of this approach with a gradual step-up approach from catheter tip to guidewire front-end to guidewire back-end. To the best of our knowledge, no studies measuring the time of recanalization of lower extremity CTOs using conventional devices were published yet. RESULTS Data of 46 consecutive chronic total iliaco-femoro-popliteal occlusions in 43 symptomatic patients treated by percutaneous transluminal angioplasty were collected prospectively between May 1st 2014 and June 30th 2016 and evaluated retrospectively. Chronic occlusion was defined as clinical symptoms or imaging features lasting more than 1 month. Patient age and gender, diabetes status, localization of occlusion, occlusion length, duration of symptoms, severity of vessel calcification, and recanalization time were assessed. Technical success was defined as placement of a catheter beyond the distal end of the lesion into the true lumen, confirmed by contrast injection. All 46 CTOs were successfully recanalized. In 22 cases (47.8%) recanalization was successful with the catheter tip only without the use of a guide wire. In 17 cases (36.9%) the guide wire was used in addition to the catheter. Localization of occlusion did not have an effect on the recanalization technique (p = 0.915). The mean rank for length of occlusion was not significant for different recanalization techniques (p = 0.095). The success rate for the catheter only approach was lower for higher grades of calcification (p = 0.008). There was no correlation between time of recanalization and length of occlusion (Pearson's r = 0.004; adjusted R square = - 0.024; p = 0.980), diabetes (p = 1.000), sex (p = 0.244), or grade of calcification (p = 0.621). Recanalization time is significantly right-skewed with most recanalizations being successful under 30 min. CONCLUSION This "catheter first" approach is somewhat contradictory to the prevailing dogma of "wire first". The concept to use the catheter to start a recanalization is well known, but to perform the entire recanalization including the re-entry seems possible and potentially less traumatic, likely leading to a longer intraluminal course. Our data shows that recanalization of occluded lower extremity arteries between the aortic bifurcation and the popliteal artery can be achieved in the majority of cases (84.7%) solely by using an angled angiographic catheter +/- glide wire. We suggest a "5 min - 15 min - 30 min" rule on how long to attempt each recanalization technique. More precisely, we suggest trying 5 min with the catheter alone, then 10 min with the soft end of the guidewire and then switching to the stiffer back-end of the guidewire for another 15 min.
Collapse
Affiliation(s)
- Marc Cunier
- Department of Radiology and Nuclear medicine, Canton Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Arash Najafi
- Department of Radiology and Nuclear medicine, Canton Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Gabriel T. Sheikh
- Department of Radiology and Nuclear medicine, Canton Hospital Winterthur, 8401 Winterthur, Switzerland
| | - Christoph A. Binkert
- Department of Radiology and Nuclear medicine, Canton Hospital Winterthur, 8401 Winterthur, Switzerland
| |
Collapse
|
6
|
Catheter-Directed Fenestration for Branch Vessel Reconnection in Aortic Dissection Using a Novel Diamond-Tipped Chronic Total Occlusion Drilling Device: A Technical Report. Cardiovasc Intervent Radiol 2018; 42:608-614. [DOI: 10.1007/s00270-018-2124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
|
7
|
Soga Y, Nakamura M, Hirose K, Ito N, Tomoi Y, Hiramori S, Ando K. Primary Use of the TruePath Crossing Device for Infrainguinal Chronic Total Occlusions With Intravascular Ultrasound Evaluation. J Endovasc Ther 2018; 25:592-598. [PMID: 30117364 DOI: 10.1177/1526602818793901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the use of the TruePath crossing device as the primary recanalization tool for infrainguinal chronic total occlusions (CTO). METHODS A retrospective analysis was conducted of 50 patients (mean age 75 years; 26 men) with 55 infrainguinal CTOs treated with the TruePath between March 2017 and September 2017 at a single center. The mean occlusion length was 138±55 mm, and femoropopliteal lesions accounted for 65% of the 55 lesions. The primary outcome measure was CTO crossing using the TruePath alone; secondary outcomes were assisted success (>50% lumen gain using the TruePath), device-related complications, and intraluminal crossing evaluated by intravascular ultrasound (IVUS). RESULTS Complete success was achieved in 33 (60%) of 55 lesions having a mean occlusion length of 145±72 mm. Among these, the true lumen crossing rate was 97% according to IVUS evaluation. Assisted success was achieved in 15 (68%) of the 22 failures. Complete/assisted success, in which the TruePath was thought to have contributed to CTO crossing, was attained in 48 (87%) of the 55 lesions. Three (5.5%) complications were observed: a perforation, an access-site hematoma, and acute occlusion; only the perforation was device related (1.8%). Multivariate analysis showed PACCS grade 4 (odds ratio 4.5, 95% confidence interval 1.33 to 15.5, p=0.02) was an independent predictor of TruePath failure. CONCLUSION Primary use of the TruePath crossing device for infrainguinal CTOs demonstrated a satisfactory complete success rate and a high rate of IVUS-documented intraluminal crossing with few device-related complications. Severe calcification is an independent predictor of TruePath failure.
Collapse
Affiliation(s)
- Yoshimitsu Soga
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Miho Nakamura
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kaoru Hirose
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhiro Ito
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Tomoi
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Seiichi Hiramori
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| |
Collapse
|
8
|
Bhatt H, Janzer S, George JC. Crossing techniques and devices in femoropopliteal chronic total occlusion intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:623-631. [DOI: 10.1016/j.carrev.2017.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
|
9
|
Abstract
Percutaneous therapies for peripheral artery disease continue to evolve with new techniques and devices. Although guidelines-recommended therapies have impacted cardiovascular morbidity and mortality, endovascular interventions have been shown to reduce limb pain, improve quality of life, and prolong walking distance for those with claudication and to reduce amputation rates among those with critical limb ischemia. Novel devices such as drug-eluting stents and drug-coated balloons have improved patency for moderate-length lesions, whereas others allow treatment of heavily calcified and tortuous segments. New adjunctive devices to cross lesions and reduce or modify associated plaque have also been developed, although level 1 data regarding their efficacy are sparse. There has also been a better mechanistic understanding of lower extremity endovascular treatment using tools such as intravascular ultrasound. This information has highlighted the need for better stent size selection for the femoropopliteal arterial segments and larger balloon diameters for the tibial arteries. Moreover, a wound perfusion approach with direct in-line flow, the so-called angiosome approach, and reconstruction of the pedal loop have been advocated for improved wound healing. Technical advances such as the tibiopedal access and reentry methods have allowed crossing of lesions that were considered no option for the endovascular approach in the past. Collectively, there has been increased awareness, interest, and commitment by various specialty societies and organizations to advance the treatment of peripheral artery disease and critical limb ischemia. This is also evident by the recent coalition of 7 professional societies and organizations that represented >150 000 allied health professionals and millions of patients with peripheral artery disease at the 2015 Centers for Medicaid and Medicare Services Medicare Evidence Development and Coverage Analysis Committee meeting. The percutaneous therapies for peripheral artery disease continue to evolve with longer follow-up with randomized data and larger prospective registries. In the future, it is hopeful that we will treat the lower extremity arteries according to segments, taking into account plaque morphology, luminal versus subintimal crossing, location, and stenotic versus occlusive disease. Until then, we must identify the most cost-effective, efficacious, and safe treatment for each patient. The goal of this article is to aid the practicing vascular specialist consider the optimal choices for the management of patients with vascular disease.
Collapse
Affiliation(s)
- Mehdi H Shishehbor
- From Heart and Vascular Institute, Cleveland Clinic, OH (M.H.S.); and the Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.)
| | - Michael R Jaff
- From Heart and Vascular Institute, Cleveland Clinic, OH (M.H.S.); and the Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.).
| |
Collapse
|
10
|
Jalal S, Lalonde TA, Yamasaki H, Boshara A, Rosman HS, Mehta RH, Davis TP. Novel CenterCross and MultiCross devices for the treatment of infrainguinal chronic total occlusions: initial single-centre experience. EUROINTERVENTION 2016; 11:1063-9. [PMID: 26788708 DOI: 10.4244/eijv11i9a214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to evaluate the effectiveness and safety of CenterCross/MultiCross devices to facilitate the crossing of chronic total occlusions in peripheral arteries. METHODS AND RESULTS This was a single-centre study in which 53 consecutive patients who were not amenable to initial attempts at crossing using standard guidewires underwent an attempt to recanalise chronically occluded infrainguinal peripheral arteries with MultiCross/CenterCross devices. The primary endpoint of interest was the ability to advance the guidewire beyond the chronic total occlusion (CTO) lesions with the use of these devices. Safety endpoints were freedom from bleeding, distal embolisation and vessel perforation, dissection or need for emergent surgical intervention. Popliteal artery and below lesions were the most commonly treated, comprising 89% of the total. The CTO lesions were crossed successfully in 92.4% of the cases within a relatively short time (5.5±3.5 minutes). There was no bleeding, dissection or need for emergent surgery and 98.1% and 96.2% of the patients were free from distal embolisation and perforations, respectively. CONCLUSIONS Our study demonstrated that MultiCross and CenterCross were effective and safe for recanalisation of peripheral CTO lesions which were not amenable to conventional guidewires. Further study is required to define the role of these novel devices in the treatment of complex lesions, particularly CTOs in patients with peripheral arterial disease.
Collapse
Affiliation(s)
- Shwan Jalal
- St. John Hospital and Medical Center, Detroit, MI, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Shimada Y. Commentary: Novel Crossing Devices vs the Skill of Artisans: Is It a Tie Thus Far? J Endovasc Ther 2015; 22:535-7. [PMID: 26187976 DOI: 10.1177/1526602815590971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoshihisa Shimada
- Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan
| |
Collapse
|
12
|
Kakkar AM, Abbott JD. Percutaneous versus surgical management of lower extremity peripheral artery disease. Curr Atheroscler Rep 2015; 17:479. [PMID: 25612856 DOI: 10.1007/s11883-014-0479-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lower extremity peripheral artery disease (PAD) is highly prevalent and can manifest as intermittent claudication or, in the most advanced form, critical limb ischemia. Revascularization, which can be accomplished by an endovascular or surgical approach, is performed to improve quality of life or, in severe cases, for limb salvage. Over the past decade, percutaneous catheter-based techniques have improved such that acute procedural success is high even in complex anatomy. Patency rates have also increased with the use of atherectomy devices and drug-eluting stents. Often, patients with PAD have comorbidities that increase the risk of cardiovascular complications with surgical procedures. These factors have led to the adoption of an endovascular first strategy with surgical management reserved for selected patients. This review focuses on the most current clinical trials of endovascular therapy for PAD. In addition, older but relevant studies comparing endovascular and surgical approaches and contemporary surgical trials are presented for reference.
Collapse
Affiliation(s)
- Amit M Kakkar
- Vascular Medicine and Endovascular Interventions, Jacobi Medical Center, 1400 Pelham Pkwy South Cardiac Cath, Bld 1, 5, West Bronx, NY, 10461, USA,
| | | |
Collapse
|
13
|
Banerjee S, Sarode K, Patel A, Mohammad A, Parikh R, Armstrong EJ, Tsai S, Shammas NW, Brilakis ES. Comparative Assessment of Guidewire and Microcatheter vs a Crossing Device-Based Strategy to Traverse Infrainguinal Peripheral Artery Chronic Total Occlusions. J Endovasc Ther 2015; 22:525-34. [PMID: 25985785 DOI: 10.1177/1526602815587707] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare success rates of a guidewire and microcatheter strategy vs the use of specialized crossing devices to traverse infrainguinal peripheral artery chronic total occlusions (CTOs). METHODS For this analysis, data on 438 consecutive infrainguinal CTO interventions in 438 patients (mean age 63.2 years; 402 men) performed between August 2006 and May 2014 were extracted from the multicenter Excellence in Peripheral Artery Disease (XLPAD) database (ClinicalTrials.gov; identifier NCT01904851). Primary technical success constituted placement of a guidewire in the true lumen, past the distal CTO cap, with the initial crossing strategy. RESULTS A wire-catheter strategy was used in 295 (67.4%) and a specialized CTO crossing device in 143 (32.6%) patients (p<0.001). Primary crossing technical success was higher with CTO devices (72.1% vs 51.9%, p<0.001). The primary wire-catheter arm used significantly more secondary CTO devices (28.1% vs 17.5%) and/or provisional re-entry devices (26.7% vs 4.9%) compared with the primary CTO device arm (both p<0.001). Secondary crossing technical success (defined as crossing with an alternate strategy: 67.5% vs 71.4%, p=1.000), provisional crossing technical success (defined as use of a re-entry device: 84.2% vs 87.5%, p=0.768), and procedure success (93.6% vs 90.9%, p=0.332) were similar between the wire-catheter and CTO device strategies, respectively. No differences were observed in periprocedural complications or 30-day adverse events; however, at 12 months, there was a significantly higher surgical revascularization rate in the primary wire-catheter arm (8.8% vs 2.8%, p=0.025). CONCLUSION Infrainguinal peripheral artery CTO crossing is frequently attempted with a wire-catheter technique; however, an initial CTO crossing device approach is associated with higher primary technical success. Overall procedure success is similar with both strategies.
Collapse
Affiliation(s)
- Subhash Banerjee
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karan Sarode
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA
| | | | - Atif Mohammad
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ehrin J Armstrong
- VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO, USA
| | - Shirling Tsai
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Emmanouil S Brilakis
- Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
14
|
Panico A, Jafferani A, Shah F, Dieter RS. Advances in Peripheral Arterial Disease Endovascular Revascularization. Cardiol Clin 2015; 33:89-98. [DOI: 10.1016/j.ccl.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Banerjee S, Hadidi O, Mohammad A, Alsamarah A, Thomas R, Sarode K, Garg P, Baig MS, Brilakis ES. Blunt microdissection for endovascular treatment of infrainguinal chronic total occlusions. J Endovasc Ther 2014; 21:71-8. [PMID: 24502486 DOI: 10.1583/12-4009mr.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To present a systematic safety evaluation of the CrossBoss blunt microdissection catheter for crossing peripheral chronic total occlusions (CTOs). METHODS Between July 2010 and July 2011, 15 patients (all men; mean age 60.7±9.1 years) underwent endovascular treatment of 17 infrainguinal CTOs that were resistant to guidewire passage, so the blunt microdissection catheter was employed to recanalize the artery. Fourteen lesions were de novo and 3 were in-stent restenoses. Sixteen lesions were in the superficial femoral artery; 8 of 17 CTOs were TASC II type D. Extensive calcification was present in 12 lesions. Mean lesion length was 182.9±66.2 mm (range 57-296). RESULTS Procedural success was 100% and successful crossing without the use of a re-entry device (technical success) was achieved in 15 cases. Twelve lesions were stented. Average fluoroscopy time was 36.5±21.2 minutes (143.8±76.9 Gy*cm (2) radiaton dose area product), during which a mean 172.1±62.2 mL of iodinated contrast were used. Two patients had access site hematomas that were treated conservatively, and there was no perforation, distal embolization, amputation, or need for urgent revascularization. During the mean follow-up of 11.4±0.1 months, 1 patient died, and none required an amputation or surgical revascularization. There was a significant improvement in ankle-brachial index (0.6±0.1 to 0.8±0.2, p=0.001) and symptoms as assessed by Rutherford class at 1 year. Four of 17 limbs required secondary revascularization procedures within 1 year. CONCLUSION 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.
Collapse
|
16
|
Banerjee S, Sarode K, Das T, Hadidi O, Thomas R, Vinas A, Garg P, Mohammad A, Baig MS, Shammas NW, Brilakis ES. Endovascular Treatment of Infrainguinal Chronic Total Occlusions Using the TruePath Device: Features, Handling, and 6-Month Outcomes. J Endovasc Ther 2014; 21:281-8. [DOI: 10.1583/13-4527r.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Selmon MR, Schwindt AG, Cawich IM, Chamberlin JR, Das TS, Davis TP, George JC, Janzer SF, Lopez LA, McDaniel HB, McKinsey JF, Pigott JP, Raja ML, Reimers B, Schreiber TL. Final Results of theChronic Total OcclusionCrossing With theOcelot System II (CONNECT II) Study. J Endovasc Ther 2013; 20:770-81. [DOI: 10.1583/13-4380mr.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|