Comparative Assessment of Guidewire and Microcatheter vs a Crossing Device-Based Strategy to Traverse Infrainguinal
Subhash Banerjee1, Karan Sarode2, Apurva Patel3
1Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA subhash.banerjee@va.gov.
Insights
Specialized devices improve initial success for infrainguinal peripheral artery chronic total occlusions (CTOs) crossing compared to wire-catheter methods. However, overall procedure success rates remain similar between strategies.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Chronic total occlusions (CTOs) in infrainguinal arteries pose significant challenges for endovascular intervention.
- Traditional guidewire and microcatheter techniques are commonly employed, but success rates can be variable.
Purpose of the Study:
- To compare the technical success rates of specialized chronic total occlusion (CTO) crossing devices versus guidewire and microcatheter strategies for infrainguinal peripheral artery CTOs.
- To evaluate secondary and provisional success rates, as well as periprocedural complications and long-term outcomes.
Main Methods:
- Analysis of 438 consecutive infrainguinal CTO interventions from the Excellence in Peripheral Artery Disease (XLPAD) database.
- Patients were categorized based on the initial crossing strategy: wire-catheter or specialized CTO crossing device.
- Primary technical success was defined as guidewire placement in the true lumen past the CTO cap with the initial strategy.
Main Results:
- Specialized CTO crossing devices demonstrated a higher primary technical success rate (72.1%) compared to the wire-catheter strategy (51.9%).
- The wire-catheter group required more secondary and provisional re-entry devices.
- Secondary crossing success, provisional crossing success, and overall procedure success were similar between the two strategies. However, the wire-catheter group had a higher surgical revascularization rate at 12 months.
Conclusions:
- Initial use of specialized CTO crossing devices is associated with higher primary technical success for infrainguinal CTOs.
- Despite differences in primary success, overall procedure success and complication rates were comparable.
- The choice of initial strategy impacts revascularization rates, suggesting a potential benefit for CTO devices in long-term outcomes.
Purpose:
To compare success rates of a guidewire and microcatheter strategy vs the use of specialized crossing devices to traverse infrainguinal peripheral artery chronic total occlusions (CTOs).
Methods:
For this analysis, data on 438 consecutive infrainguinal CTO interventions in 438 patients (mean age 63.2 years; 402 men) performed between August 2006 and May 2014 were extracted from the multicenter Excellence in Peripheral Artery Disease (XLPAD) database (ClinicalTrials.gov; identifier NCT01904851). Primary technical success constituted placement of a guidewire in the true lumen, past the distal CTO cap, with the initial crossing strategy.
Results:
A wire-catheter strategy was used in 295 (67.4%) and a specialized CTO crossing device in 143 (32.6%) patients (p<0.001). Primary crossing technical success was higher with CTO devices (72.1% vs 51.9%, p<0.001). The primary wire-catheter arm used significantly more secondary CTO devices (28.1% vs 17.5%) and/or provisional re-entry devices (26.7% vs 4.9%) compared with the primary CTO device arm (both p<0.001). Secondary crossing technical success (defined as crossing with an alternate strategy: 67.5% vs 71.4%, p=1.000), provisional crossing technical success (defined as use of a re-entry device: 84.2% vs 87.5%, p=0.768), and procedure success (93.6% vs 90.9%, p=0.332) were similar between the wire-catheter and CTO device strategies, respectively. No differences were observed in periprocedural complications or 30-day adverse events; however, at 12 months, there was a significantly higher surgical revascularization rate in the primary wire-catheter arm (8.8% vs 2.8%, p=0.025).
Conclusion:
Infrainguinal peripheral artery CTO crossing is frequently attempted with a wire-catheter technique; however, an initial CTO crossing device approach is associated with higher primary technical success. Overall procedure success is similar with both strategies.
