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First Experience With The GoBack-Catheter For Successful Crossing of Complex Chronic Total Occlusions in Lower Limb
Olaf Bakker1,2, Yvonne Bausback3, Tim Wittig3
1Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
Insights
The GoBack-catheter effectively recanalizes complex chronic total occlusions in lower limb arteries, achieving a 92.1% technical success rate with a low complication rate in peripheral vascular interventions.
Area of Science:
- Endovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Complex peripheral artery disease often involves chronic total occlusions (CTOs) that are challenging to treat with conventional endovascular techniques.
- Guidewire crossing failure is a common limitation in treating these complex lesions, necessitating alternative approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of the GoBack-catheter for complex revascularizations in lower limb arteries.
- To assess the technical success rate and complication profile of the GoBack-catheter in treating chronic total occlusions where guidewire crossing failed.
Main Methods:
- A retrospective single-center study analyzed 101 limb revascularizations in 100 consecutive patients using the GoBack-catheter.
- All treated lesions were chronic total occlusions (CTOs) with prior guidewire crossing failure, including de novo, reocclusions, and in-stent reocclusions.
- Technical success was defined as successful CTO crossing with the study device; patency was assessed by duplex sonography at discharge and 30 days.
Main Results:
- The GoBack-catheter achieved an overall technical success rate of 92.1% in crossing complex CTOs, including heavily calcified lesions and occluded stents.
- The device was utilized across various anatomical locations (femoropopliteal, iliac, tibial arteries) and access techniques (antegrade, retrograde).
- Minor bleeding occurred in 3 patients, and 30-day adverse limb events included minor amputations (4.0%), major amputation (1.0%), and reocclusions (6.9%).
Conclusions:
- The GoBack-catheter demonstrates versatile endovascular applicability for complex CTO recanalization in peripheral vascular interventions.
- It offers a high technical success rate and a low complication rate, making it a valuable tool for challenging lower limb revascularizations.
Purpose:
To evaluate the use of the GoBack-catheter (Upstream Peripheral Technologies) in complex revascularizations in lower limb arteries.
Materials And Methods:
In this retrospective single-center study, the results of the first 100 consecutive patients including 101 limb-revascularizations, performed between May 2018 and July 2020 with the study device, were analyzed. In all cases, guidewire-crossing failed, and all lesions were chronic total occlusions (CTO), either de novo, reocclusions, or in-stent reocclusions. Successful crossing was defined as passing the CTO using the study device. Patency at discharge and after 30 days was defined as less than 50% restenosis on duplex sonography, without target lesion revascularization.
Results:
Median lesion length was 24 cm and 38 patients (37.6%) had a calcium grading according to the peripheral arterial calcium scoring system (PACSS) of 4 or 5. In 20.8% of patients, an occluded stent was treated. CTOs involved the femoropopliteal segment in 91.1%, iliac arteries in 5.9%, and tibial arteries in 7.9%. The GoBack-catheter was employed for entering into or crossing through parts or the full length of a CTO or an occluded stent as well as for re-entering into the true lumen after subintimal crossing. The device was used via contralateral and ipsilateral antegrade as well as retrograde access with an overall technical success rate of 92.1%. In 3 patients minor bleeding occurred at the crossing or re-entry site, which were managed conservatively. Thirty-day adverse limb events comprised minor amputations in 4 patients (4.0%), 1 major amputation (1.0%), and reocclusions in 7 limbs (6.9%).
Conclusion:
The new GoBack-catheter offers versatile endovascular applicability for complex CTO recanalization in a broad range of peripheral vascular interventions with a high technical success and low complication rate.
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