The revascular active percutaneous interventional device for coronary total occlusions study
Daniel Chamié1, Alexandre Abizaid, José Ribamar Costa
1Interventional Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brasil.
Insights
The novel RVT CTO Guidewire Device (RVT-GDW) shows promise for crossing chronic total occlusions (CTOs) in coronary arteries. This first-in-man study found the device to be safe and effective, achieving a 62.5% procedural success rate.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has limited success, often due to difficulty crossing lesions.
- A novel guidewire system, the RVT CTO Guidewire Device (RVT-GDW), was developed to address these challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of the RVT-GDW for crossing complex CTO lesions.
- To assess the feasibility of a new guidewire system in a first-in-man study.
Main Methods:
- The RAPID-CTO study was a non-randomized, single-center, first-in-man trial.
- The RVT-GDW features a mechanically active distal end, a torquer handle, and a control unit for enhanced crossing and positioning.
- The device was used after conventional guidewires failed to cross the lesion for at least 5 minutes of fluoroscopy time.
Main Results:
- 16 patients with CTOs were treated using the RVT-GDW.
- Procedural success was achieved in 10 lesions (62.5%), with an average procedural time of 111.43 minutes.
- No major adverse cardiac events were reported during in-hospital or 30-day follow-up.
Conclusions:
- The RVT-GDW device is technically feasible, safe, and effective for crossing chronically occluded coronary arteries.
- Further investigation in larger studies is warranted to confirm these findings.
Background:
Despite the well-documented benefit of recanalization of an occluded vessel in some symptomatic patients, attempt is only performed in a minority of them. Percutaneous coronary intervention (PCI) of CTO is associated with high incidence of complications and unsuccessful procedure, mainly due to inability to cross the lesion. We sought to evaluate the efficacy and safety of the novel RVT CTO Guidewire Device (RVT-GDW, ReVascular Therapeutics, Sunnyvale, CA) in this complex scenario.
Methods:
The RAPID-CTO study is a non-randomized, single center, first-in-man evaluation of a new guidewire system for treatment of CTO. The RVT-GDW is a new device designed to provide enhanced penetration and positioning control for crossing CTO via: (1) an 0.014 "guidewire with a mechanically active distal end; (2) a handle attached proximally to the guidewire, with an adjustable torquer, and interfaced to (3) a non-disposable, battery-operated, control unit, that provides activation control and audio feedback during the CTO crossing procedure. Per protocol, the RVT-GDW device was only used after at least 5 min (fluoroscopy time) of attempt with commercially available conventional guidewires to cross the target lesion.
Results:
A total of 16 patients (16 lesions) were treated with the RVT-GDW. Mean age was 56.25 years, 56.2% were men, and 25% diabetics. The average duration of occlusion was 4.7 +/- 2.1 months. The mean vessel reference diameter was 2.76 +/- 0.31 mm and the mean lesion length was 16.64 +/- 7.70 mm (range 4.37-35.0 mm). Thirteen patients (81.2%) had "tapered stump" morphology at the proximal end of the occlusion, and a side branch was involved in 12 (75.0%). All lesions had contralateral circulation; bridging collaterals were seen in three (18.7%). Procedural success was achieved in 10 lesions (62.5%), with an average procedural time of 111.43 +/- 35.76 min. There were no major adverse cardiac events at both in-hospital and 30-day clinical follow-up.
Conclusions:
The first-in-man RAPID-CTO study suggests that the novel RVT-GDW device is technically feasible, safe and effective in crossing chronically occluded coronary arteries. Larger studies are warranted.
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