"Seesaw balloon-wire cutting" technique is superior to Tornus catheter in balloon uncrossable chronic total occlusions

BACKGROUND

Inability to advance a balloon is a well-recognized cause leading to a failure in recanalization of chronic total occlusions (CTOs) despite successfully passing a guidewire. A few techniques and devices have been introduced to facilitate balloon passage, especially the use of Tornus catheter. However, complex manipulation, expensive cost, and availability limit the application of these methods. This study was to evaluate the efficiency and safety of "seesaw balloon-wire cutting" technique in comparison with Tornus catheter for balloon uncrossable CTOs.

METHODS

Eighty patients with balloon uncrossable CTOs were enrolled in this study. Among them, 40 patients treated with "seesaw balloon-wire cutting" technique were consecutively investigated and 40 patients treated with Tornus catheter before were matched retrospectively. A rotablator or retrograde strategy was taken as a bail-out strategy. Success rates of device and procedure and complication rate were assessed. Complications included coronary dissection, cardiac tamponade, death, Q-wave myocardial infarction (MI), non-Q-wave MI, emergency PCI and bypass surgery.

RESULTS

Compared with the Tornus catheter, device success rate was significantly higher with the "seesaw balloon-wire cutting" technique (87.5% vs. 45.0%, P<0.001), and the mean procedural time was much shorter (90.5±8.3min vs. 141.5±21.3min, P<0.001). The procedural success rate was also higher with the "seesaw balloon-wire cutting" technique (92.5% vs.72.5%, P=0.037). There were no differences in complication rate.

CONCLUSION

The "seesaw balloon-wire cutting" technique is superior to the Tornus catheter in treating balloon uncrossable CTOs.

Transradial Approach for Chronic Total Occlusion Percutaneous Coronary Intervention

Over the last two decades, the transradial approach has gained an important role in interventional cardiology. A large body of evidence exists supporting the safety and feasibility of the transradial approach in a broad spectrum of patients and settings. In addition, the transradial approach has been applied with good results for chronic total occlusion (CTO) recanalization. This article provides an overview of basic principles and techniques required to perform successful transradial CTO percutaneous coronary intervention.