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Safety and efficacy of dedicated guidewire and microcatheter technology for chronic total coronary occlusion revascularization

principal results of the Asahi Intecc Chronic Total Occlusion Study

Kandzari, David E.a; Grantham, J. Aaronb; Karmpaliotis, Dimitriosc; Lombardi, Williamd; Moses, Jeffrey W.c; Nicholson, Williame; Cook, Stephenf; Pershad, Ashishg; Popma, Jeffrey J.h

doi: 10.1097/MCA.0000000000000668
Coronary Intervention

Background Limited study has detailed the procedural outcomes and utilization of contemporary coronary guidewires and microcatheters designed for chronic total occlusion (CTO) percutaneous revascularization and with application of modern techniques.

Patients and methods A prospective, multicenter, single-arm trial was conducted to evaluate procedural and in-hospital outcomes among 163 patients undergoing attempted CTO revascularization with specialized guidewires and microcatheters. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction, or repeat target vessel revascularization (major adverse cardiac events).

Results The prevalence of diabetes was 42.9%; prior myocardial infarction, 41.1%; and previous bypass surgery, 36.8%. Average (mean±SD) CTO length was 41±29 mm, and mean Japanese CTO score was 2.6±1.3. A guidewire support catheter was used in 91.7% of cases, and the mean number of CTO-specific guidewires per procedure was 3.1±2.9. Overall, procedural success was observed in 73.0% of patients. The rate of successful guidewire recanalization was 89.0%, and absence of in-hospital major adverse cardiac event was 81.0%. Methods included antegrade (45.4%), retrograde (5.5%) and combined antegrade/retrograde techniques (49.1%). Total mean procedure time was 119±68 min; mean radiation dose, 2613±1881 mGy; and contrast utilization, 287±142 ml. Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 13 (8.0%) patients.

Conclusion In this multicenter, prospective registration trial representing contemporary technique, favorable procedural success and early clinical outcomes inform technique and strategy using dedicated CTO guidewires and microcatheters in a high lesion complexity patient population.

aPiedmont Heart Institute, Atlanta, Georgia

bSt Luke’s Mid-America Heart Institute and the University of Missouri Kansas City, Kansas City, Missouri

cDivision of Cardiology, Columbia University Medical Center, New York, New York

dDivision of Cardiology, University of Washington, Seattle, Washington

eWellSpan Cardiology, York, Pennsylvania

fOregon Heart and Vascular Institute, Springfield, Oregon

gBanner Health-University Medical Center, Phoenix, Arizona

hDepartment of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Correspondence to David E. Kandzari, MD, Piedmont Heart Institute, Suite 2065, 95 Collier Road, Atlanta, GA 30309, USA Tel: +1 404 605 5526; fax: +1 404 720 0911; e-mail: david.kandzari@piedmont.org

Received September 13, 2018

Accepted September 18, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.