Intraluminal Recanalization of Long Infrainguinal Chronic Total Occlusions Using the Crosser System

Abstract

¤ ¤Purpose: To assess the safety and efficacy of a device for vibrational angioplasty in the percutaneous intraluminal recanalization of long infrainguinal chronic total occlusions (CTO).Technique: The Crosser CTO Recanalization System is a mechanical recanalization device that uses high-frequency vibrational energy to disrupt and channel through fibrocalcific plaque without harming the vessel wall, thus assisting in the recanalization of an occluded artery. In 12 diabetic patients (7 men; median age 71 years, range 58-80) with critical limb ischemia owing to long (median length 26 cm, range 21-32) infrainguinal CTOs resistant to conventional guidewire techniques, the Crosser CTO Recanalization System was successful in intraluminally crossing the occlusion in 9 (75%) patients in ,5 minutes (mean 4:03 minutes). The safety endpoint (distal lumen guidewire position with no vessel perforation or dissection) was achieved in all successful cases. Conclusion: In our preliminary experience, the Crosser CTO Recanalization Catheter decreased crossing time, was safe, and achieved a high rate of intraluminal recanalization of long infrainguinal CTOs.

Endovascular Intervention for Peripheral Artery Disease

“…The Crosser CTO system (Bard Peripheral), which relies on vibrational energy to penetrate and dissect through plaque, has been described in a few small, singlecenter observational series. 108,109 The TruePath CTO (Boston Scientific) system is designed with a 0.0018″ diamond tip rotating at 13 000 rpm for mechanical recanalization. The Turbo Elite catheter (Spectranetics), which delivers short pulses of ultraviolate energy to ablate athersclerotic tissue and thrombus, has been investigated in the Laser-assisted Angioplasty for Critical Ischemia international registry of 145 patients and showed a technical success rate (defined as residual stenosis <50%) of 86%.…”

Novel devices and specialized techniques in recanalization of peripheral artery chronic total occlusions (CTOs) — A literature review

“…However, sparse data are published in peripheral vasculature about the utilization of this device. Gandini et al [1] have reported their experience with the Crosser catheter used in 12 diabetic patients (12 lesions) with critical limb ischemia (CLI) and had a success rate of 75% in their series, all of which were refractory to conventional guidewire techniques. The Crosser catheter was unsuccessful to cross the CTOs in two cases, and one case failed due to misplacement of the guide sheath in a false lumen.…”

“…Prolonged fluoroscopy exposure and higher contrast loads may also be used due to the complex nature of CTOs. Most patients with peripheral artery CTOs suffer from critical limb ischemia or disabling claudication [1]. The conventional technique using standard guidewires and catheters can achieve an initial success in about 40%-60% of cases [2], depending on lesion characteristics (length, location, calcification and runoff vessel status) and operator's experience.…”

Chronic total occlusions in peripheral vasculature: techniques and devices

“…In their preliminary experience with crosser system, Gardini et al reported decreased crossing time, safety, and a high rate (75%) of intraluminal recanalization of long infrainguinal CTOs [34]. In a recently completed 6-month ana lysis by Allie et al, in approximately 100 CTOs, they were able to obtain first-line true luminal crossing in 90% of the cases without a single perforation or complication.…”