Angioplasty for chronic total occlusion by using tapered‐tip guidewires

Abstract

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still technically challenging. The use of tapered-tip guidewires in these lesions may improve the success rate of PCI. In order to avoid the needless radiation exposure or contrast consumption, we have to determine a guideline for the termination of procedures in these lesions. We retrospectively analyzed the data of 182 patients between April 1997 and December 1999 (phase 1) and 80 patients between January and August 2001 (phase 2) who underwent angioplasty for CTO lesions ≥ 3 months. There were no significant differences in clinical or lesion characteristics except the use of tapered-tip guidewires. Tapered-tip guidewires were used in 60% of patients in phase 2 period but no patients in phase 1 period. The overall success rate of PCI was improved from 67% in phase 1 to 81% in phase 2 (P ‫؍‬ 0.019). In the phase 2 period, the success rate was higher in tapered-type occlusion (P ‫؍‬ 0.002) and shorter length of occlusion (P ‫؍‬ 0.004). Total procedure time was 46 ؎ 17 min and total volume of contrast dye was 180 ؎ 63 ml. The success rate was higher in patients treated by transradial coronary intervention (TRI) than transfemoral coronary intervention (89% vs. 64%; P ‫؍‬ 0.008). The use of tapered-tip guidewires can improve the success rate of PCI in CTO lesions. The following guideline for the termination of the procedures is reasonable: time from arterial access to successful penetration of a guidewire through occlusion ≤ 30 min; total procedure time ≤ 90 min; and total dye volume ≤ 300 ml. TRI can achieve a high success rate even in CTO lesions provided that the case selection is adequate. Cathet Cardiovasc Intervent 2003; 59:305-311.

Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists

“…Such concepts are strongly supported by our study which shows increasing success rates despite worse angiographic features. Similar results were observed in the specific setting of TRA CTO PCI by other authors [5,10].…”

“…Our data suggest that in a dedicated TRA centre TRA can be considered also for highly complex PCI like CTO. The possible relevance of TRA experience in TRA CTO PCI is also suggested by the highly variable rate of access failure reported by previously published studies [5,[10][11][12][13]. Moreover, since access crossovers are mainly due to anatomical variants of radial and subclavian arteries [11], the ability to promptly recognize and appropriately overcome upper limb anatomic variants [14] is probably pivotal to successfully complete the procedure by TRA.…”

Three-Dimensional Quantitative Volumetry of Chronic Total Occlusion Plaque Using Coronary Multidetector Computed Tomography

“…21-23 Thus, CTO PCI is currently limited by how well the CTO lesion can be negotiated. 24 PCI of CTO lesions is often a technical challenge, and the unpredictable and lengthy amount of time required for the procedure complicates the efficiency of operators and catheterization labs. Most new devices for CTO are still experimental.…”

A Case Report on Percutaneous Coronary Intervention in Chronic Total Occlusion by Retrograde Visualization

“…More aggressive CTO wires may cause damage to the tortuous proximal segments before reaching the occlusion. [7] When wire enters a false channel, it is left in place in the dissection plane as marker and a second guide wire is passed along the same path parallel to the first wire (Parallel Wire Technqiue). PW technique has two main purpose:a) redirecting a wire inside the body of the CTO and b) puncturing distal CTO fibrous cap.PW technique has been shown to increase success rate after failed attempt with the conventional single wire technique.…”