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CTO crossing device improves technical success vs. wire-catheter strategy
Among patients who received infrainguinal chronic total occlusion interventions, use of a specialized crossing device was associated with higher primary technical success when compared with a guidewire and microcatheter strategy, despite the latter being performed in more than two-third of cases.
Subhash Banerjee, MD, of the Veteran Affairs North Texas Healthcare System, Dallas, and colleagues gathered data on 438 consecutive patients (mean age, 63 years; 91.8% men) who received infrainguinal CTO interventions. Procedures were performed from August 2006 to May 2014 and were collected from the multicenter Excellence in Peripheral Artery Disease (XLPAD) database.
Subhash Banerjee
The researchers defined primary crossing technical success as placement of a guidewire in the true lumen — past the distal CTO cap — with the initial strategy; secondary crossing technical success as crossing with an alternate strategy; and provisional crossing technical success as use of a re-entry device.
In all, 67.4% of patients received the wire-catheter strategy and 32.6% received a specialized CTO crossing device (P < .001).
Results indicated that primary technical success was increased in the CTO device arm (72.1% vs. 51.9%; P < .001). More secondary CTO devices (28.1% vs. 17.5%) and/or provisional re-entry devices (26.7% vs. 4.9%; P for both < .001) were used in the primary wire-catheter arm.
In addition, rates of procedure success, secondary crossing technical success and provisional crossing technical success were similar between groups, and there were no differences in periprocedural complications or 30-day adverse events.
However, the researchers reported a difference in the rate of surgical revascularization at 12 months, which was higher in the primary wire-catheter arm (8.8% vs. 2.8%; P = .025).
According to the researchers, the higher rate of primary crossing success with CTO devices may suggest improved penetration and the ability to maintain an intraluminal course, as well as enhanced navigation through dense fibrocalcific occlusive lesions with CTO crossing devices.
“Although the primary wire-catheter strategy was associated with lower primary crossing success, overall procedure success rates were high and not statistically different due to significantly greater utilization of secondary crossing and provisional re-entry devices following an initial wire-catheter failure,” Banerjee and colleagues wrote. – by Brian Ellis
Disclosure: Banerjee reports receiving research grants from Boston Scientific and The Medicines Company; consultant/speaker honoraria from Boehringer Ingelheim, Cordis, Gilead, Medtronic, Sanofi and St. Jude; ownership of Mdcare (spouse); and intellectual property in HygeiaTel. Please see the full study for a list of all other researchers’ relevant financial disclosures.