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

Liang, Gang; Zhang, Fu Xian

doi:10.1016/j.ijcard.2012.03.033

Cited by 16 publications

(13 citation statements)

References 46 publications

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“…The device is first advanced through the CTO in the closed grasper configuration, after which it is pulled back in the open grasper configuration for compression and disruption. In a small prospective study by Mossop et al procedural success was achieved in 91% of resistant peripheral CTOs, with no complication related to the device itself [6,17].…”

Section: ) Compression By Instrumentmentioning

confidence: 94%

“…By describing the underlying working principles of the treatment tools and relating these principles to the clinical environment in which they are used, potential solutions to currently encountered challenges, such as the previously described crossing and treatment difficulties in CTOs, and new creative ideas for recanalizing total occlusions can emerge. Even though some reviews exist that give an overview of the current treatment tools used during PCIs of CTOs (e.g., [2,6,7]), never before have these treatment tools been fundamentally discussed from a force-delivery point-of view. Furthermore, by looking deeper into the treatment tools designed specifically for chronic and acute lesions in the different vascular beds, a much broader picture is sketched of the entire field of treatment tools.…”

Section: Introductionmentioning

confidence: 99%

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Treating Total Occlusions: Applying Force for Recanalization

Sakes

Regar

Dankelman

et al. 2016

IEEE Rev. Biomed. Eng.

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Section: ) Compression By Instrumentmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Treating Total Occlusions: Applying Force for Recanalization

Sakes

Regar

Dankelman

et al. 2016

IEEE Rev. Biomed. Eng.

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“…Nowadays, the market offers many devices dedicated for revascularization of SFA CTO -non-imaging-guides catheters such as Crosser, TruePath, Frontrunner, but only one of these has built-in optical coherence tomography (OCT) -the Ocelot catheter [5][6][7]. The OCT provides spatial resolution that is ten times greater compared to intravascular ultrasound (IVUS) currently applied in atherectomy devices [8].…”

Section: Introductionmentioning

confidence: 99%

Five-year outcomes after revascularization of superficial femoral artery occlusion using Ocelot catheter

Nowakowski

Buszman

Janas³

et al. 2019

pwki

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Introduction: The population of patients with lower limb atherosclerosis includes a considerable proportion of individuals with long superficial femoral artery (SFA) lesions. Chronic total occlusions (CTOs) represent the "last frontier" of percutaneous interventions. While open strategies are considered earlier as standard management for these lesions, the results of a number of trials indicate that endovascular management might become an effective alternative to surgery. Material and methods: This paper presents 5-year outcomes of a first-in-man (FIM) study (before CE mark) and the registry of OCT Guided Ocelot Catheter (Avinger) for chronic total occlusions of the superficial femoral artery. The study group comprised 10 patients with Rutherford 3 lower limb ischemia including nine men and one woman. Results: The efficacy of the primary intervention was 90%. Angiography performed at 6 months of the procedure, according to the study protocol, revealed 3 and 1 cases of restenosis and reocclusion, respectively, repaired using PTA and open common and deep femoral artery patch plasty. Doppler ultrasound performed at 1, 2 and 5 years after the primary intervention did not reveal significant target vessel restenosis. The primary and primary-assisted patency was 89%. During a 5-year follow-up, four peripheral percutaneous interventions and one femoropopliteal bypass surgery were performed in non-target limbs. There were no cardiovascular deaths, myocardial infarction or stroke and no amputation was required. Conclusions: This is a first-in-man study reporting long-term follow-up after SFA CTO revascularization using the Ocelot catheter. The catheter proved to have a satisfactory safety profile and a high proportion of CTO crossings. A 5-year follow-up revealed high primary and primary-assisted patency rates.

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“…Even though some reviews exists that describe the current state-of-the-art in crossing devices specifically designed for CTOs, these reviews are incomplete as they mainly focus on providing an overview of currently applied devices; excluding the patented literature. 30 , 55 , 63 This study explores the entire field, including the patented literature, and systematically reviews the state-of-the-art of all existing and invented crossing devices and methods for crossing total occlusions, including acute occlusions (which are usually softer (thrombotic) than CTOs, which are mainly characterized by heavy calcification), used in clinical practice and designs described in the patented literature. The study ends in a discussion in which we identify future research pathways that could lead to a fundamental improvement in the field.…”

Section: Introductionmentioning

confidence: 99%

Crossing Total Occlusions: Navigating Towards Recanalization

Sakes

Regar

Dankelman

et al. 2016

Cardiovasc Eng Tech

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Chronic total occlusions (CTOs) represent the “last frontier” of percutaneous interventions. The main technical challenges lies in crossing the guidewire into the distal true lumen, which is primarily due to three problems: device buckling during initial puncture, inadequate visualization, and the inability to actively navigate through the CTO. To improve the success rate and to identify future research pathways, this study systematically reviews the state-of-the-art of all existing and invented devices for crossing occlusions. The literature search was executed in the databases of Scopus and Espacenet using medical and instrument-related keyword combinations. The search yielded over 840 patents and 69 articles. After scanning for relevancy, 45 patents and 16 articles were included. The identified crossing devices were subdivided based on the determinant for the crossing path through the occlusion, which is either the device (straight and angled crossing), the environment (least resistance, tissue selective, centerline, and subintimal crossing) or the user (directly steered and sensor enhanced crossing). It was found that each crossing path is characterized by specific advantages and disadvantages. For a future crossing device, a combination of crossing paths is suggested were the interventionist is able to exert high forces on the CTO (as seen in the device approach) and actively steer through the CTO (user: directly steered crossing) aided by intravascular imaging (user: sensor enhanced crossing) or an intrinsically safe device following the centerline or path of least resistance (environment: centerline crossing or least resistance crossing) to reach the distal true lumen.

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

Cited by 16 publications

References 46 publications

Treating Total Occlusions: Applying Force for Recanalization

Treating Total Occlusions: Applying Force for Recanalization

Five-year outcomes after revascularization of superficial femoral artery occlusion using Ocelot catheter

Crossing Total Occlusions: Navigating Towards Recanalization

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