'Seesaw Balloon-Wire Cutting' and Chronic Total Occlusions
'Seesaw Balloon-Wire Cutting' and Chronic Total Occlusions
Background. Balloon crossing failure after passing a guidewire usually leads to unsuccessful percutaneous recanalization of chronic total occlusions (CTOs). We sought to investigate a novel technique for solving this problem.
Methods. Twenty-one patients with failed balloon crossing through CTOs after successful guidewire passing were treated with the "seesaw balloon-wire cutting" technique between July 2012 and May 2013. The main process of this technique was to insert two guidewires (guidewire A and guidewire B) into the distal true lumen of CTOs and then to advance two short and low-profile balloons (balloon A and balloon B) over the two guidewires, respectively. Balloon A was first advanced over guidewire A as distally as possible, and then was inflated with high pressure (≥18 atm) to press guidewire B, producing a cutting power to crush the proximal fibrous cap of the CTO. Subsequently, balloon A was withdrawn slightly, and balloon B was advanced as distally as possible and then was inflated to press guidewire A, producing a similar cutting effect to crush the proximal fibrous cap on the other side. The two balloons were progressed alternatively until one of them was able to cross through the occluded segment.
Results. This new technique was successfully applied in 17 patients (81.0%), leading to procedural success of their CTOs. The technique failed in 4 patients (19.0%) due to heavy calcification. No complications occurred in all patients.
Conclusion. The seesaw balloon-wire cutting technique is an effective and safe approach to facilitate balloon crossing during CTO interventions.
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) represents one of the "last frontiers" in interventional cardiology. Despite the expertise of operators and the development of novel interventional techniques and devices, the procedural success rate of CTOs remains significantly lower than in non-occluded lesions. The greatest challenge of CTO recanalization is to cross guidewires and balloons through the occluded segment. Although the CTO-dedicated guidewires have improved the success rate of guidewire crossing, the subsequent balloon passage through the occlusion is still difficult under some circumstances, which usually leads to procedural failure of CTO recanalization. Recently, a number of techniques and devices have been introduced to facilitate balloon crossing through CTOs, including the use of more supportive guiding catheters, "child-in-mother" guide system, anchor balloon technique, Tornus catheter, excimer laser, and rotational atherectomy. However, complex manipulation, expensive cost, and availability limit the application of these methods. Therefore, we attempted to invent an easy, low-cost, and more effective technique for facilitating balloon passage through CTOs.
Abstract and Introduction
Abstract
Background. Balloon crossing failure after passing a guidewire usually leads to unsuccessful percutaneous recanalization of chronic total occlusions (CTOs). We sought to investigate a novel technique for solving this problem.
Methods. Twenty-one patients with failed balloon crossing through CTOs after successful guidewire passing were treated with the "seesaw balloon-wire cutting" technique between July 2012 and May 2013. The main process of this technique was to insert two guidewires (guidewire A and guidewire B) into the distal true lumen of CTOs and then to advance two short and low-profile balloons (balloon A and balloon B) over the two guidewires, respectively. Balloon A was first advanced over guidewire A as distally as possible, and then was inflated with high pressure (≥18 atm) to press guidewire B, producing a cutting power to crush the proximal fibrous cap of the CTO. Subsequently, balloon A was withdrawn slightly, and balloon B was advanced as distally as possible and then was inflated to press guidewire A, producing a similar cutting effect to crush the proximal fibrous cap on the other side. The two balloons were progressed alternatively until one of them was able to cross through the occluded segment.
Results. This new technique was successfully applied in 17 patients (81.0%), leading to procedural success of their CTOs. The technique failed in 4 patients (19.0%) due to heavy calcification. No complications occurred in all patients.
Conclusion. The seesaw balloon-wire cutting technique is an effective and safe approach to facilitate balloon crossing during CTO interventions.
Introduction
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) represents one of the "last frontiers" in interventional cardiology. Despite the expertise of operators and the development of novel interventional techniques and devices, the procedural success rate of CTOs remains significantly lower than in non-occluded lesions. The greatest challenge of CTO recanalization is to cross guidewires and balloons through the occluded segment. Although the CTO-dedicated guidewires have improved the success rate of guidewire crossing, the subsequent balloon passage through the occlusion is still difficult under some circumstances, which usually leads to procedural failure of CTO recanalization. Recently, a number of techniques and devices have been introduced to facilitate balloon crossing through CTOs, including the use of more supportive guiding catheters, "child-in-mother" guide system, anchor balloon technique, Tornus catheter, excimer laser, and rotational atherectomy. However, complex manipulation, expensive cost, and availability limit the application of these methods. Therefore, we attempted to invent an easy, low-cost, and more effective technique for facilitating balloon passage through CTOs.
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