Recanalization of chronic and long occlusive in-stent restenosis using optical coherence reflectometry-guided radiofrequency ablation guidewire

Recanalization of chronic total peripheral arterial occlusions using optical coherent reflectometry with guided radiofrequency energy: A single center experience

BACKGROUND

A forward-looking, fiberoptic guided device (Safe-Cross System, Intraluminal Therapeutics, Carlsbad, CA) has been used with guided radiofrequency energy to open chronic total occlusions (CTOs). This report describes the use of optical coherent reflectometry (OCR) system to assess safety and efficacy of opening CTOs in native peripheral arteries in the lower extremities: iliac, femoral, and popliteal.

METHODS

18 CTOs in native peripheral arteries in 17 patients were treated with OCR after failed attempts with conventional wires (minimum 10 min of fluoroscopic time). When the CTO was crossed, routine angioplasty with or without stent was performed. Efficacy was defined as achievement of distal lumen position. Safety was defined as device success without perforation, dissection (> or =Grade C), or distal embolization. The mean patient age was 72 years with 8 females and 10 males. Lesion characteristics included a mean vessel diameter of 5.8 mm and a mean lesion length of 22.4 cm. Ankle-brachial indices was < or =0.8 in all patients.

RESULTS

The OCR system was successful in crossing 100% of the CTOs in patients that failed conventional wire crossing, whereas clinical success occurred in 94% of these patients. Complications consisted of a single dissection > or =Grade C. No perforations or distal embolization occurred.

CONCLUSIONS

The Safe-Cross OCR System is both efficacious and safe in the treatment of CTOs that failed crossing with conventional wires and indirect visualization of the intraluminal position by using OCR technology appears to minimize vessel trauma, dissection, perforation, and distal embolization.

The feasibility of percutaneous transradial coronary intervention for chronic total occlusion

We evaluated the feasibility of the transradial coronary intervention (TRCI) in 85 consecutive patients with chronic total occlusion (CTO). Clinical, angiographic and procedural factors were compared between the success and failure groups. An overall success rate of 65.5% (57 of 87 lesions) was achieved with TRCI, and the most common cause of failure was an inability to pass the lesion with a guidewire. A multivariate analysis demonstrated that the most significant predictor of failure was the duration of occlusion (OR 1.064 per month, 95% CI 1.005 to 1.126, p = 0.03). The procedural success rate improved with use of new-generation hydrophilic guidewires. The 6 Fr guiding catheters were used in the majority of the 70 cases (81%). Five cases were crossed over to a femoral artery approach due to engagement failure of the guiding catheter into the coronary ostium because of severe subclavian tortuosity and stenosis in two cases, radial artery looping in one case, and poor guiding support in two cases. There were no major entry site complications. In conclusion, the radial artery might be a feasible vascular route in coronary interventions for CTO, with comparable procedural success and no access site complications.

Resolution of protein-losing enteropathy after radiofrequency perforation and subsequent stent implantation for relief of complete occlusion of a redirected left superior vena cava

The application of radiofrequency (RF) technologies in the treatment of congenital heart defects has provided a safe and effective alternative to conventional therapies in the restoration of vascular patency for a variety of arterial and venous occlusions. This report concerns an 8-year old girl that developed protein-losing enteropathy and elevated central venous pressure after occlusion of a surgically redirected anomalous draining left superior vena cava (SVC). Cardiac catheterization revealed complete obstruction of the anastomosis of the SVC into the coronary sinus. Transcatheter recanalization by RF perforation and subsequent stent implantation led to the restoration of upper venous blood flow and the resolution of her symptoms.

Usefulness of optical coherent reflectometry with guided radiofrequency energy to treat chronic total occlusions in peripheral arteries (the GRIP trial)

Optical coherent reflectometry, a forward-looking, fiberoptic-guided device was used in 72 patients to direct radiofrequency energy across the central intraluminal portion of 75 chronic total occlusions in peripheral arteries (iliac, femoral, and popliteal) that failed attempts with conventional guidewires. The system was successful in crossing 76% of the chronic total occlusions with no clinical perforations or distal embolizations, and complications consisted of a single dissection greater than or equal to grade C.

Improved recanalization of chronic total coronary occlusions using an optical coherence reflectometry-guided guidewire

Successful percutaneous therapy of chronic total occlusions is limited predominantly by the inability to cross the lesion. We report our experience of 29 chronic total occlusions (CTOs) that could not be crossed with conventional wires and subsequently underwent attempted recanalization facilitated using a wire navigated with optical coherence reflectometry. Mean length of occlusion was 22.1 mm (range, 4.5-88.7 mm). Successful recanalization was achieved in a further 15 (51.7%), with no complications of tamponade, myocardial infarction, or death. These results demonstrate that this wire can be a useful tool in addition to conventional wires in the treatment of CTO.

Percutaneous recanalization of chronic subclavian artery occlusion using optical coherence reflectometry-guided radiofrequency ablation guidewire

Subclavian artery lesion that is associated with low complication rate could be treated by percutaneous intervention effectively. However, the success of endovascular therapy for occlusive lesion may be limited by failure to cross with a guidewire. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through subclavian artery occlusion that could not be crossed by conventional guidewires.

Initial experience and safety in the treatment of chronic total coronary occlusions with a new optical coherent reflectometry-guided radiofrequency ablation guidewire

The Safe-Cross wire system, which has optical coherence reflectometry technology for navigating and radiofrequency energy provided at its tip for crossing chronic total occlusions (CTOs), provides a promising means to treat hard, organized CTOs. Using this system, we report on a 60% success rate in patients who had long-standing coronary CTOs that had > or =1 failed attempt using conventional percutaneous coronary intervention.