Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques: results of the FAST-CTOs (Facilitated Antegrade Steering Technique in Chronic Total Occlusions) trial
Patrick L Whitlow, M Nicholas Burke, William L Lombardi, R Michael Wyman, Jeffrey W Moses, Emmanouil S Brilakis, Richard R Heuser, Charanjit S Rihal, Alexandra J Lansky, Craig A Thompson, FAST-CTOs Trial Investigators, David A Cox, Joseph Babb, Franz Reisdorf, Jeng Mah, Patrick L Whitlow, M Nicholas Burke, William L Lombardi, R Michael Wyman, Jeffrey W Moses, Emmanouil S Brilakis, Richard R Heuser, Charanjit S Rihal, Alexandra J Lansky, Craig A Thompson, FAST-CTOs Trial Investigators, David A Cox, Joseph Babb, Franz Reisdorf, Jeng Mah
Abstract
Objectives: This study sought to examine the efficacy and safety of 3 novel devices to recanalize coronary chronic total occlusions (CTOs).
Background: Successful percutaneous coronary intervention (PCI) of CTOs improves clinical outcome in appropriately selected patients. CTO PCI success, however, remains suboptimal.
Methods: A new crossing catheter and re-entry system was evaluated in a prospective, multicenter, single-arm trial of CTO lesions refractory to standard PCI techniques. The primary efficacy endpoint was the frequency of true lumen guidewire placement distal to the CTO (technical success).
Results: Enrollment included 147 patients with 150 CTOs. The mean lesion length was 41 ± 17 mm. A crossing catheter crossed 56 lesions into the distal true lumen, and a re-entry catheter facilitated tapered-wire cannulation of the distal lumen in 59 CTOs initially crossed subintimally (77% technical success). Success in the first 75 CTOs was 67%, rising to 87% in the last 75 CTOs. Mean fluoroscopy and procedure times were 45 ± 16 min and 90 ± 12 min, respectively, each significantly shorter than in historical controls (p < 0.0001 for both). Coronary perforation occurred in 14 cases (9.3%), requiring treatment in 3 cases (prolonged balloon inflation, with additional coil embolization in 1 case). No tamponade or hemodynamic instability occurred. Six patients had periprocedural non-ST-segment elevation myocardial infarction. No emergency surgery, ST-segment elevation myocardial infarction, or cardiac reintervention occurred. Two deaths occurred within 30 days, neither as a direct result of the procedure. The 30-day major adverse cardiac event rate was 4.8%.
Conclusions: In CTOs failing standard techniques, use of a new crossing and re-entry system results in a high success rate without increasing complications.
Trial registration: ClinicalTrials.gov NCT00886899.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed