Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: The CrossBoss First Trial
Karacsonyi J, Tajti P, Rangan BV, Halligan SC, Allen RH, Nicholson WJ, Harvey JE, Spaedy AJ, Jaffer FA, Grantham JA, Salisbury A, Hart AJ, Safley DM, Lombardi WL, Hira R, Don C, McCabe JM, Burke MN, Alaswad K, Koenig GC, Sanghvi KA, Ice D, Kovach RC, Varghese V, Murad B, Baran KW, Resendes E, Martinez-Parachini JR, Karatasakis A, Danek BA, Iwnetu R, Roesle M, Khalili H, Banerjee S, Brilakis ES. Randomized comparison of a crossboss first versus standard wire escalation strategy for crossing coronary chronic total occlusions: The crossboss first trial. JACC Cardiovasc Interv. Feb 12 2018;11(3):225-233.
JACC Cardiovasc Interv
OBJECTIVES: The authors performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions.
BACKGROUND: There is equipoise about the optimal initial strategy for crossing coronary chronic total occlusions.
METHODS: The primary endpoints were the time required to cross the chronic total occlusion or abort the procedure and the frequency of procedural major adverse cardiovascular events. The secondary endpoints were technical and procedural success, total procedure time, fluoroscopy time required to cross and total fluoroscopy time, total air kerma radiation dose, total contrast volume, and equipment use.
RESULTS: Between 2015 and 2017, 246 patients were randomized to the CrossBoss catheter (n = 122) or wire escalation (n = 124) at 11 U.S. centers. The baseline clinical and angiographic characteristics of the study groups were similar. Technical and procedural success were 87.8% and 84.1%, respectively, and were similar in the 2 groups. Crossing time was similar: 56 min (interquartile range: 33 to 93 min) in the CrossBoss group and 66 min (interquartile range: 36 to 105 min) in the wire escalation group (p = 0.323), as was as the incidence of procedural major adverse cardiovascular events (3.28% vs. 4.03%; p = 1.000). There were no significant differences in the secondary study endpoints.
CONCLUSIONS: As compared with wire escalation, upfront use of the CrossBoss catheter for antegrade crossing of coronary chronic total occlusions was associated with similar crossing time, similar success and complication rates, and similar equipment use and cost.
Medical Subject Headings
Aged; Cardiac Catheterization; Cardiac Catheters; Chronic Disease; Coronary Angiography; Coronary Occlusion; Female; Hospital Costs; Humans; Male; Middle Aged; Operative Time; Percutaneous Coronary Intervention; Postoperative Complications; Risk Factors; Time Factors; Treatment Outcome; United States