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ChoICE PT wire for recanalization of chronically occluded coronary arteries: multiple wires in one?
1Associate Professor of Medicine, Department of Medicine, Room 1928, Block K, Queen Mary Hospital, Pokfulam, Hong Kong. dswho@hku.hk
Insights
Modifying the ChoICE guidewire by cutting its tip improves success rates for percutaneous transluminal coronary angioplasty (PTCA) in chronic total occlusions. This technique offers a cost-effective solution, enhancing guidewire utility and patient outcomes.
Area of Science:
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) for chronic total occlusions (CTO) presents significant technical challenges, often requiring multiple guidewires and yielding limited success rates.
- Existing PTCA guidewires, including the ChoICE polymer-tip (PT) wire, face difficulties in navigating tortuous and occluded vessels, leading to increased procedure time and cost.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel technique involving the modification of the ChoICE PT guidewire by resecting its distal tip for CTO interventions.
- To assess the impact of this modification strategy on guidewire crossing success rates and the overall need for multiple guidewires during CTO procedures.
Main Methods:
- A retrospective analysis of 50 consecutive CTO cases utilizing the ChoICE PT wire was conducted.
- The distal 4 cm of the ChoICE PT wire was progressively cut and reshaped as needed to overcome lesion resistance and kinking.
- Guidewire crossing success rates were documented before any resections and after one, two, and three resections.
Main Results:
- Cumulative crossing success rates increased significantly with each resection: 26% (0 resections), 48% (1 resection), 82% (2 resections), and 84% (3 resections).
- The strategy allowed for multiple uses of a single guidewire, reducing the need for additional devices.
- No procedural complications such as perforations, deaths, myocardial infarctions, or need for bypass surgery were reported.
Conclusions:
- Progressively resecting the distal tip of the ChoICE PT wire is a safe and effective strategy to enhance guidewire performance in CTO interventions.
- This technique significantly improves crossing success rates, optimizes guidewire utility, and potentially reduces costs associated with CTO procedures.
- The ability to modify the guidewire on-demand offers a practical solution for challenging CTO lesions.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) of chronic total occlusions may be technically difficult and the success rate is limited despite increasing operator experience and improvements in PTCA hardware. The number of guidewires required to cross totally occluded lesions is higher than that for stenotic lesions. The ChoICE polymer-tip (PT) wire (Boston Scientific/Scimed, Inc., Maple Grove, Minnesota) is a relatively new stainless-steel core wire with a hydrophilic-coated polyurethane tip. Though never described in the literature, we found that the distal 4 cm of the wire can be cut and reshaped according to the operator's needs. Thus, instead of reshaping a kinked tip or using another new wire, the former being time-consuming and the latter expensive, one can simply cut off the kinked tip and start again with a "new wire." As the tip is resected, the wire becomes progressively more "intermediate-like" and "standard-like." We report our experience with the ChoICE PT wire in 50 consecutive cases of chronic total occlusions. The cumulative crossing success rates were 13/50 (26%) before any resections, 24/50 (48%) after 1 resection, 41/50 (82%) after 2 resections and 42/50 (84%) after 3 resections. There were no perforations, deaths, myocardial infarctions or need for bypass surgery. Our findings suggest that successful recanalization of chronic total occlusions can be achieved with a high success rate using the ChoICE PT wire. A strategy of progressively resecting the more floppy and kinked distal end can provide multiple uses from a single wire, optimizing recanalization success and obviating the need for additional wires.