ABSTRACT
We demonstrated a first-in-human case of successful antegrade dissection and re-entry using an image-guided re-entry catheter that enables real-time high-resolution visualization with graphical augmentation, and precision steering and advancement of a guidewire. The total time from over-the-wire deployment in the proximity of the distal cap to successful re-entry was <20 minutes. (Level of Difficulty: Advanced.).
ABSTRACT
OBJECTIVES AND BACKGROUND: Recanalization of a chronic total occlusion (CTO) is technically challenging with less than optimum results in arterial disease. Crosser® is a novel technology that utilizes high frequency (20 KHz) vibration energy to fragment occlusive fibrous atherosclerotic plaque and helps in traversing the occluded vessel. We report a single center experience with this catheter as the primary device in peripheral chronic total occlusions. METHODS: The catheter was used as the primary device in 25 consecutive patients with peripheral CTOs. The peripheral CTOs in this study are defined as 100% occluded vessels involving any segment of the iliac artery or below the inguinal ligament down to the trifurcation vessels which have been occluded for greater than 3 months judged by patient's history of longstanding symptoms with no worsening in the past 3 months. Procedural success was defined by the ability of the device to facilitate guide wire crossing of the occlusion. All angiograms were evaluated by two operators. Data on demographics, angiographic variables, and patient complications was collected. RESULTS: The device was used in 25 consecutive patients and 27 CTO lesions were treated. Critical limb ischemia and claudication were the indications in 32 and 68% of the patients, respectively. Average lesion length was 117 mm (range 10-300 mm). Superficial femoral artery was the most common lesion site (n = 20, 74%). Crosser-assisted guide wire recanalization was achieved in 11(41%) lesions while the final overall procedure success rate with any device was 63% (n = 17). Perforation occurred in five lesions with one directly attributable to this device. CONCLUSIONS: In this single center observational review, the Crosser device in peripheral CTO lesions had a procedural success of 41%. © 2010 Wiley-Liss, Inc.
Subject(s)
Angioplasty/instrumentation , Arterial Occlusive Diseases/therapy , Catheters , Iliac Artery , Intermittent Claudication/therapy , Ischemia/therapy , Lower Extremity/blood supply , Popliteal Artery , Aged , Angioplasty/adverse effects , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnostic imaging , Chi-Square Distribution , Chronic Disease , Constriction, Pathologic , Equipment Design , Female , Humans , Iliac Artery/diagnostic imaging , Intermittent Claudication/diagnostic imaging , Intermittent Claudication/etiology , Ischemia/diagnostic imaging , Ischemia/etiology , Male , Middle Aged , Popliteal Artery/diagnostic imaging , Radiography , Treatment Outcome , Vibration/therapeutic use , Wounds, Penetrating/etiologyABSTRACT
The use of directional coronary atherectomy (DCA) in current practice has been limited. The SilverHawk System is a newly developed plaque excision device that aims to overcome the drawbacks of prior DCA platforms. The device was evaluated in a porcine coronary model and in a series of patients. Procedural variables along with outcomes were reviewed. Quantitative angiography (QCA) was performed and excised tissue fragments were weighed and examined histologically. In porcine cases, pretreatment MLD increased from 0.51 +/- 0.26 to 2.36 +/- 0.59 mm postdebulking and 19.9 +/- 7.6 mg of tissue was retrieved. In human cases, pretreatment MLD increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 mm postdebulking and 15.2 +/- 7.8 mg of tissue was retrieved without complications. These data show that the SilverHawk System may offer significant utility in treating a wide variety of complex coronary lesions.
