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Related Experiment Video

Updated: Mar 26, 2026

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Crossing Total Occlusions: Navigating Towards Recanalization.

Aimée Sakes1, Evelyn Regar2, Jenny Dankelman3

  • 1Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands. a.sakes@tudelft.nl.

Cardiovascular Engineering and Technology
|February 3, 2016
PubMed
Summary
This summary is machine-generated.

Crossing chronic total occlusions (CTOs) is challenging. This review categorizes CTO crossing devices by their approach, highlighting advantages and disadvantages for future innovations in percutaneous interventions.

Keywords:
Chronic total occlusions (CTO)CrossingPercutaneous coronary intervention (PCI)RecanalizationReviewState of the artTreatment

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Area of Science:

  • Cardiovascular Interventions
  • Medical Device Technology
  • Biomedical Engineering

Background:

  • Chronic total occlusions (CTOs) present significant challenges in percutaneous coronary interventions.
  • Successful guidewire crossing into the distal true lumen is often hindered by device buckling, poor visualization, and navigation limitations.

Purpose of the Study:

  • To systematically review existing and novel devices for crossing CTOs.
  • To identify future research directions for improving CTO intervention success rates.

Main Methods:

  • A comprehensive literature search was conducted using Scopus and Espacenet databases.
  • Keywords focused on medical and instrument-related terms for CTO crossing devices.
  • 45 patents and 16 articles were selected after initial screening of over 840 patents and 69 articles.

Main Results:

  • Crossing devices were classified into three categories based on the crossing path determinant: device, environment, or user.
  • Each crossing strategy (e.g., device-based, environment-guided, user-controlled) exhibits unique benefits and drawbacks.
  • Identified devices include straight/angled crossing, least resistance, tissue selective, centerline, subintimal, directly steered, and sensor-enhanced crossing.

Conclusions:

  • Future CTO crossing devices should ideally integrate multiple crossing strategies.
  • Combining high force application (device approach) with active steering (user approach) is recommended.
  • Incorporating intravascular imaging or centerline/least resistance navigation enhances safety and efficacy.