Recanalization of Total Coronary Occlusions Using a Laser Guidewire (The European TOTAL Surveillance Study)

Abstract

The success rates of coronary angioplasty for the treatment of chronic total occlusions are less favorable than for coronary stenosis. Therefore, a new laser guidewire (LW) was designed to facilitate the crossing of chronic total occlusions. We report on the results of a European multicenter surveillance study, evaluating the laser guidewire performance. Between May 1994 and July 1996, 345 patients (age 59 +/- 10 years, 291 men) with chronic total occlusions were enrolled in 28 European centers. The median age of occlusion was 29 weeks (range 2 to 884), the occlusion length 19 +/- 10 mm. LW recanalization was successful in 205 patients (59%/). LW perforation occurred in 73 patients (21%), with hemodynamic consequences in 4 (1%). There were no deaths, emergency coronary artery bypass graft surgery, or Q-wave myocardial infarctions. In a multivariate regression analysis an occlusion age of <40 weeks (p = 0.001, RR = 1.34) and an occlusion length <30 mm (p = 0.01, RR = 1.59) were independent predictors of success. Results indicate that the LW is an effective and safe tool in the treatment of chronic total occlusion refractory to conventional guidewires.

A novel approach to chronic total occlusions: The crosser system

“…This perforation was contained (Ellis 1) and the case was a procedural success. Guidewire perforation is a well recognized complication of CTO recanalization with an incidence as high as 39% in a previous pilot study of the laser wire [14]. Therefore, our overall complication rate is low and comparable or lower than studies of dedicated guidewires or other new devices [15][16][17].…”

Comparison of the Predictive Roles of Risk Scores of In-Hospital Major Adverse Cardiovascular Events in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…As our study showed, SS-II is effective in determining in-hospital adverse events. A review of the relevant literature reveals that no previous studies have compared SS-II to other risk scoring systems designed to assess clinical risk and the extent of CAD [20][21][22]. In this study, we first compared 4 scoring systems.…”

Recanalization of chronic coronary occlusions using a new hydrophilic guidewire

“…Further studies are warranted to determine the safety, efficacy, and cost-effectiveness of this new guidewire and to compare it with other guidewire systems, such as other hydrophilic wires or the more sophisticated but more expensive excimer laser wire [24].…”