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Graham JJ, Bagai A, Wijeysundera H, Weisz G, Rinfret S, Dick A, Jolly SS, Schaempert E, Mansour S, Dzavik V, Henriques JPS, Elbarouni B, Vo MN, Teefy P, Goodhart D, Mancini GBJ, Strauss BH, Buller CE. Collagenase to facilitate guidewire crossing in chronic total occlusion PCI-The Total Occlusion Study in Coronary Arteries-5 (TOSCA-5) trial. Catheter Cardiovasc Interv 2022; 99:1065-1073. [PMID: 35077606 DOI: 10.1002/ccd.30101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/29/2021] [Accepted: 01/09/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Chronic total occlusions (CTO) are common and are associated with lower percutaneous coronary intervention (PCI) success rates, often due to failure of antegrade guidewire crossing. Local, intralesional delivery of collagenase (MZ-004) may facilitate guidewire crossing in CTO. AIMS To evaluate the effect of MZ-004 in facilitating antegrade wire crossing in CTO angioplasty. METHODS A total of 76 patients undergoing CTO PCI were enrolled at 13 international sites: 38 in the randomized training stage (collagenase [MZ-004] 900 or 1200 μg) and 38 in the placebo-controlled stage (MZ-004 900 or 1200 μg or placebo). Patients received the MZ-004 or identical volume saline (placebo group) in a double-blind design, injected via microcatheter directly into the proximal cap of the CTO. The following day patients underwent CTO PCI using antegrade wire techniques only. RESULTS Patients were generally similar except for a trend for higher Japanese chronic total occlusion (J-CTO) score in the MZ-004 group (MZ-004 J-CTO score 1.9 vs. 1.4, p = 0.07). There was a numerical increase in the rates of guidewire crossing in the MZ-004 groups compared to placebo (74% vs. 63%, p = 0.52). Guidewire crossing with a soft-tip guidewire (≤1.5 g tip load) was significantly higher in the MZ-004 groups (0% in placebo, 17% in 900 μg, and 29% in 1200 μg MZ-004 group, p = 0.03). Rates of the major adverse cardiovascular event were similar between groups. CONCLUSION Local delivery of MZ-004 into coronary CTOs appears safe and may facilitate CTO crossing, particularly with softer tipped guidewires. These data support the development of a pivotal trial to further evaluate this agent.
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Affiliation(s)
- John J Graham
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harindra Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Giora Weisz
- Department of Cardiology, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Stéphane Rinfret
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alexander Dick
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanjit S Jolly
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Samer Mansour
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Vladimir Dzavik
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jose P S Henriques
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Basem Elbarouni
- St. Boniface General Hospital Winnipeg, Winnipeg, Manitoba, Canada
| | - Minh N Vo
- St. Boniface General Hospital Winnipeg, Winnipeg, Manitoba, Canada
| | - Patrick Teefy
- Department of Medicine, Cardiology Division, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - David Goodhart
- Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - G B John Mancini
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Christopher E Buller
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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