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Crosswire for recanalization of total occlusive coronary arteries
V K Bahl1, S Chandra, K C Goswami
1Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi.
Insights
The Cross-wire guidewire improved success rates for coronary angioplasty in total occlusions, achieving 83% recanalization with good safety. This technique offers a viable option for challenging coronary artery blockages.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary angioplasty for total occlusions presents significant technical challenges and limited success rates.
- Procedural success is heavily influenced by the specific pathological characteristics of the occlusion.
- Recanalization aims to navigate occlusions safely, avoiding dissection or perforation.
Purpose of the Study:
- To evaluate the efficacy and safety of the new 0.014" Nitinol Cross-wire guidewire in treating total coronary occlusions.
- To determine the success rate of recanalization using the Cross-wire in challenging coronary lesions.
- To assess the immediate and short-term outcomes of balloon angioplasty and stenting following Cross-wire use.
Main Methods:
- Balloon angioplasty was performed on 30 totally occluded coronary arteries.
- The Cross-wire guidewire was used electively after initial attempts with conventional wires failed in five cases.
- Lesion crossing, procedural success, complications, and angiographic results were analyzed.
Main Results:
- Successful lesion crossing was achieved in 90% (27/30) of cases using the Cross-wire.
- Overall successful recanalization with the Cross-wire was expected in 83% of cases.
- Good immediate angiographic results were obtained in 21 patients undergoing balloon angioplasty and stenting, with no myocardial infarctions or deaths.
Conclusions:
- The Cross-wire guidewire demonstrates a high success rate (83%) for recanalization of total coronary occlusions.
- The technique is associated with reasonable safety, with low rates of dissection (7%).
- Successful recanalization facilitates subsequent balloon angioplasty and stenting, leading to favorable patient outcomes.
Abstract:
Coronary angioplasty of total occlusions is technically difficult and is associated with limited success rates. The procedural outcome is mainly determined by the underlying pathological process. Recanalization of total occlusions is aimed at finding the passage with least resistance, without causing dissection or perforation. Several techniques have been advocated to improve the overall success rate. Recently, a new 0.014" Nitinol wire (Crosswire, Terumo) has been introduced as a tool, to achieve higher success rates for total occlusion angioplasty. The wire consists of an extremely flexible Nitinol-core, a platinum/iridium coil at the distal tip, and a hydrophilic polymer coating. Balloon angioplasty was attempted in 30 totally occluded coronary arteries with mean age of occlusion being 5 +/- 4 months (range 2-14 months). The initial five procedures were performed following failure of the conventional angioplasty guidewires. Subsequently, Cross-wire was used electively in all the cases. The lesion was crossed successfully in 90% (27/30) cases. Dissection of the coronary artery with subintimal entry was seen in two (7%) cases, and the rest (three cases) could not be crossed. Balloon angioplasty and stenting (n = 21) were performed with good immediate angiographic results. There were no myocardial infarctions or deaths. Fourteen of 16 patients, who had completed 6 months follow-up, were asymptomatic. Angiographic evidence of in-stent restenosis was demonstrable in one case. Successful recanalization of total coronary occlusions by using Cross-wire can be expected in 83% cases, with reasonable safety.