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Chronic total occlusions: experience with fiber-optic guidance technology--optical coherence reflectometry
1Phoenix Heart Center, St. Luke's Medical Center, 525 North 18th St., Suite 504, Phoenix, AZ 85006, USA.
Insights
New optical guidewire technology successfully crosses chronic total occlusions in 86% of cases. This "forward-looking" system improves visualization, aiding interventional cardiologists in treating complex blockages.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
Background:
- Chronic total occlusions (CTO) present significant challenges in interventional cardiology.
- Guidewire navigation across CTOs is often limited by poor visualization.
- Existing guidewires lack the necessary technology to safely steer through occlusions.
Purpose of the Study:
- To evaluate the efficacy of a novel fiber-optic guidance system for crossing CTOs.
- To assess the performance of the Safe-Steer TO Crossing System in clinical practice.
Main Methods:
- The Safe-Steer TO Crossing System utilizes optical coherence reflectometry (OCR) for guidewire navigation.
- OCR employs near-infrared light reflection intensity to differentiate tissue types (plaque vs. arterial wall).
- A prospective clinical study was conducted on patients with CTO and confirmed ischemia.
Main Results:
- The system achieved an 86% (24/28) success rate in crossing chronic total occlusions.
- The average length of the occluded lesions treated was 41.1 +/- 30.8 mm.
- Initial clinical experience demonstrated considerable success with the Safe-Steer System.
Conclusions:
- The optical guidewire technology, specifically the Safe-Steer System, is a viable option for treating CTOs.
- Improved visualization through OCR enhances guidewire crossing success rates.
- This technology offers a promising advancement for interventional cardiologists managing complex arterial blockages.
Abstract:
Chronic total occlusions are difficult to treat and continue to challenge the interventional cardiologist. The primary difficulty is safely crossing the total occlusion with a guidewire before any revascularization can begin. One of the main reasons conventional and newer guidewires have not proven effective is simply the lack of visualization to safely steer the guidewire across the occlusion. This limitation can be overcome with new technology using a "forward-looking" fiber-optic guidance. The Safe-Steer TO (Total Occlusion) Crossing System is a new guidance system that uses optical coherence reflectometry to steer a guidewire through total occlusions. Optical coherence reflectometry uses algorithms to determine tissue types (plaque vs arterial wall) by measuring the intensity of the reflection of near-infrared light. The authors' clinical experience with the Safe-Steer System has met considerable success. With their initial 28 patients (7 women, 21 men) with known chronic total occlusions and confirmed ischemia, the primary success rate for the crossing the occlusion was 86% (24/28 cases). The average occluded lesion length was 41.1 +/- 30.8 mm. Our initial clinical experience demonstrates that the optical guidewire is a viable technology in the treatment of chronic total occlusions.
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