Tornus catheter and rotational atherectomy in resistant chronic total occlusions

Although the inability to cross the chronic total occlusion (CTO) with a guidewire is the most common reason for failure, one of the most frustrating situations that may occur during a recanalization procedure is when a guidewire crosses successfully but it is impossible to advance any device over the wire through the occluded segment. We assessed the application of the Tornus catheter and/or rotational atherectomy to improve the success rate of percutaneous recanalization of CTO.

From October 2009 to May 2011, 55 consecutive patients with CTO resistant to recanalization by conventional techniques were treated by the following step-by-step approach: 1) Tornus catheter and 2) eventual high speed rotational atherectomy.

Twenty-four lesions were successfully crossed by the Tornus catheter (43.5%). Rotational atherectomy was used in 31 patients (one with Tornus success and 30 with Tornus failure). A final angiographic success was obtained in 50/55 patients (91%) whereas in 5 patients both bail-out strategies failed (9%). As compared to the 24 CTO successfully treated by the Tornus catheter (Tornus-success group), the 31 patients in the Tornus-failure group were treated more often with the 2.1F Tornus catheter and had more severely calcified lesions. By multivariable regression analysis the single independent predictor of Tornus failure was the presence of severely calcified lesions.

The Tornus catheter is a safe and effective device allowing us to overcome the inability to cross a CTO with a balloon catheter in approximately 45% of cases. In severely calcified CTO rotational atherectomy should be performed first.