TCT-414 Safety and Efficacy of Dedicated Guidewire, Microcatheter, and Guide Catheter Extension Technologies for Chronic Total Coronary Occlusion Revascularization: Primary Results of the Teleflex Chronic Total Occlusion Study
Kandzari D, Alaswad K, Jaffer FA, Brilakis E, Croce K, Kearney K, Spaedy A, Yeh R, Thompson C, Nicholson W, Wyman RM, Riley R, Lansky A, and Karmpaliotis D. TCT-414 Safety and Efficacy of Dedicated Guidewire, Microcatheter, and Guide Catheter Extension Technologies for Chronic Total Coronary Occlusion Revascularization: Primary Results of the Teleflex Chronic Total Occlusion Study. J Am Coll Cardiol 2021; 78(19):B169-B170.
J Am Coll Cardiol
Background: Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited.
Methods: A prospective, multicenter, single-arm trial was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization using specialized guidewires, microcatheters, and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events [MACE]).
Results: The prevalence of diabetes was 32.7%, of prior MI was 48.0%, and of previous bypass surgery was 32.7%. Average (mean ± SD) CTO length was 46.9 ± 20.5 mm, and mean J-CTO score was 1.9 ± 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Devices used included guidewire support microcatheters in 100% and guide catheter extensions in 64.0%, and the mean number of CTO-specific guidewires per procedure was 5.11 ± 3.52. Overall, procedural success was observed in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and the rate of absence of in-hospital MACE was 80.7%. Methods included antegrade (54.0%), retrograde (1.3%), and combined antegrade and retrograde techniques (44.7%). Total mean procedure time was 149 ± 91 minutes, mean radiation dose was 2,219 ± 1,608 mGy, and mean contrast utilization was 205 ± 95 mL. Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 patients (10.7%).
Conclusion: In a multicenter, prospective registration trial, favorable procedural success and early clinical outcomes were achieved in a patient population with high lesion complexity using contemporary techniques and application of dedicated CTO guidewires, microcatheters, and guide catheter extensions. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)