ElectroCautery-Facilitated Crossing (ECFC) of Chronic Total Occlusions
Neupane S, Basir M, and Alaswad K. ElectroCautery-Facilitated Crossing (ECFC) of Chronic Total Occlusions. J Am Coll Cardiol 2019; 74(13):B225.
J Am Coll Cardiol
Background: The use of electrocautery (EC) facilitated re-entry in an aorto-ostial chronic total occlusion (CTO) of right coronary artery (RCA) was described in 2016. Since then, it has been utilized sporadically, but little is reported about the use of EC in lesion crossing during CTO percutaneous coronary intervention (PCI). Methods: We report a case-series of EC facilitated crossing of both aorto-ostial and nonaorto-ostial CTOs where standard techniques are either not suitable or ineffective. We utilized high tip-load, stiff, and tapered 0.014-inch guidewires energized with EC in a crossing wire uncrossable CTO cap. Results: A total of 293 CTO PCIs were performed at our institution between October 16, 2016, and October 30, 2018, and ECFC was performed in 6 (2%) cases: 5 retrograde and 1 both antegrade and retrograde. All 6 cases were classified as very difficult by J-CTO score (3). ECFC led to successful crossing of CTO using EC in 5 (83%) CTO lesions. ECFC was performed in 2 aorto-ostial RCA CTOs, 3 lesions at the major bifurcation, and 1 lesion in the proximal obtuse marginal. One CTO lesion was at a stent fracture at the distal RCA bifurcation; ECFC failed to cross the occlusion both antegrade and retrograde. There were no ECFC-related complications (Figues A to D). [Figure presented] Conclusion: The use of energized stiff guidewire to perform ECFC can be of great value for CTO lesions when standard CTO techniques fail. ECFC should only be performed with caution at experienced and high-volume CTO PCI centers to avoid complications.