Evaluation for the efficacy and safety of the crosser catheter as a CTO crossing device and a flossing device

Abstract

The Crosser catheter is a unique device that facilitates antegrade intraluminal recanalization by high-frequency vibration energy and cavitation. We used this device not only as a chronic total occlusion (CTO) crossing device, but also as a flossing device in stenotic lesions and we also evaluated the efficacy of this device when used with both the "Crosser preceding" and the "Guidewire preceding" in CTOs. Complications related to this device were investigated, too. We retrospectively analyzed a total of 90 consecutive patients with peripheral artery disease in the femoropopliteal artery and below-the-knee artery (BTA). Primary technical success was defined as the successful delivery of this device into the distal true lumen. Secondary technical success was defined as successful revascularization. The safety endpoints were events of angiographic complications, including the occurrence of detachment of the metal tip from the shaft, slow flow, dissections, and perforations. Overall primary technical success rate was 93.3% and the secondary technical success rate was 96.7%. Detachment and slow flow occurred 14.4 and 4.4%, respectively, with no occurrences of either dissection or perforation. A predictor of detachment was Proposed Peripheral Arterial Calcium Scoring System (PACSS) grade 4 (OR 14.6; CI 1.26-168.5; P = 0.032). The Crosser catheter is useful not only as a CTO crossing device used with both the "Crosser preceding" and the "Guidewire preceding", but also as a flossing device in stenotic lesions. But we have to pay attention to complications related to the Crosser.

Two-Wire Technique With a Gooseneck Snare to Bail Out the Tip Separation of a Crosser Catheter

“…They also demonstrated that a Proposed Peripheral Arterial Calcium Scoring System grade of 4 was a predictor of these complications. 4…”

“…1 –3 Recently, the detachment and complete separation of the tip of the Crosser catheter was reported as a serious complication of the Crosser system. 4 However, there is limited information on bailout methods for this complication. Here, we describe a case of successful retrieval of the separated tip of a Crosser catheter using a 2-wire technique with a gooseneck snare.…”

A Case of Picking Calcified Plaque In The Common Femoral Artery With A Long Needle: The “Calc-Pick Technique”

“…Recent advances in endovascular therapy (EVT) devices have reported effectiveness of EVT for CFA 2 . Some reports have shown that balloon dilation enlarges the lumen by passing multiple wire routes within calci ed plaques 3 . However, it is not easy to pass guidewire through hard plaque.…”

A Successful Case of Endovascular Therapy for Severely Calcified Plaque Removed by Biopsy Forceps at the Superficial Femoral Artery

“…In recent years, several EVT techniques for removing calci ed lesions, such as the crossbow technique (Crosser® supported by a bent 0.014-in wire) [4] and Pierce technique (percutaneous direct needle puncture of the calci ed plaque) [5], have been reported. However, these techniques have shown a limited ability in reducing calcium volume.…”