A novel penetration catheter (Tornus) as bail-out device after balloon failure to recanalise long, old calcified chronic occlusions

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Failure to cross a calcified tight stenosis or chronic total occlusion (CTO) with a balloon after having passed a guidewire is a rare but serious intricacy with a high likelihood of failure. We report our experience of a three years period (December 2004-November 2007) using a novel metal penetration catheter (Tornus) to bail-out 44 failures to cross a lesion with a balloon catheter. The Tornus (Asahi Intecc, Aichi, Japan), an over-the-wire metal exchange catheter that might be "screwed" counter-clockwise into a lesion, was used in 44/2881 PCI-patients with calcified and tortuous coronary anatomy in whom a 1.5 mm lubricious balloon catheter could not be pushed into the lesion despite optimal support of a 6 Fr guiding catheter and additional anchoring with a stiff-shafted guidewire (anchor wire) when applicable. In 39/421 patients the target was a chronic total occlusion and in 5/2460 patients it was a stenotic lesion or recent occlusion. In these 44 consecutive balloon-failures the Tornus completely passed 35 lesions (79.5%) - all but one were successfully followed with a balloon and stent. In one patient, the balloon did not follow despite successful passage of the Tornus. In 5/9 patients in whom the Tornus passed incompletely, the channel was opened sufficiently to allow for successful passage with a balloon. In three failures to dilate after Tornus, the procedure was successfully finished with the use of a Rotablator. Three of the 44 finally failed. Over all, the Tornus procedure relevantly contributed to success in 91% of the cases with failure of balloon crossing. We experienced no complications or fractures. The Tornus is an easy to use over-the-wire device to increase a coronary channel and enhance balloon entry of complex tight lesions and chronic total occlusions.