Abstract
To improve the success rates of chronic total occlusion (CTO) intervention, a large range of CTO-dedicated guidewires (GWs), devices and techniques have been developed. However, such an abundant choice of materials confuses inexperienced operators. Therefore, the usefulness of a simple antegrade treatment algorithm with a limited set of GWs, for easy to intermediate lesions, was investigated. Between November 2011 and March 2013, 105 patients were included, who underwent CTO PCI following the algorithm. Lesions were classified according to the Multicenter CTO Registry of Japan score. Overall technical success was achieved in 77%. Study endpoint was successful GW crossing within 30 min and was reached in 57%. High success rates were achieved in easy (81%) and intermediate (64%) lesion types. In both types, a soft wire could successfully cross in 57% and 51% respectively, with the Fielder XT
Highlights
In 15% - 30% of all coronary angiograms performed in patients with single or multivessel coronary artery disease, at least one coronary chronic total occlusion (CTO) is present [1,2,3]
40% of these patients are treated medically or a large portion of these patients is referred for coronary artery bypass grafting (CABG) surgery, especially those with multivessel disease and a high syntax-score [3]
A simple step-up approach with the new generation of wires and microcatheters might result in reduced failure rates in easy CTO lesions and those with intermediate difficulty
Summary
In 15% - 30% of all coronary angiograms performed in patients with single or multivessel coronary artery disease, at least one coronary chronic total occlusion (CTO) is present [1,2,3]. 40% of these patients are treated medically or a large portion of these patients is referred for coronary artery bypass grafting (CABG) surgery, especially those with multivessel disease and a high syntax-score [3] This reluctance to perform percutaneous coronary intervention (PCI) has historically been driven mainly by anatomical factors, related to the CTO. A large range of CTO-dedicated GWs and devices have been developed to reduce treatment failure rates Such an abundant choice of GW types, all with specific characteristics (polymer-coated vs non-coated; jacket vs sleeve coatings; spring vs non-spring coil; low vs high tip load; ...) confuses the operator, being unable to build up sufficient experience with one type or set of wires, especially in low or intermediate PCI volume centers. A simple step-up approach with the new generation of wires and microcatheters might result in reduced failure rates in easy CTO lesions and those with intermediate difficulty
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