Document Type : Short Communication
Authors
- Mohsen Mohandes 1
- Sergio Rojas 1
- Jordi Guarinos 1
- Francisco Fernández 2
- Xavier Oliva 2
- Marianela Noueched 2
- Alfredo Bardaji 3
1 Honorary Professor, Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Universitat Rovira Virgili, Tarragona, Spain
2 Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Tarragona, Spain
3 Professor, Cardiology Division, Joan XXIII University Hospital, Universitat Rovira Virgili, Tarragona, Spain
Abstract
BACKGROUND: Balloon advancement and dilation through chronic total occlusion segment could be challenging in some cases after successful wire crossing. The purpose of this study was to evaluate efficacy and safety of Tornus catheter in percutaneous coronary intervention of chronic total occlusion in hard or balloon-uncrossable chronic total occlusion. METHODS: The present study is a retrospective and descriptive analysis of 14 hard or balloon-uncrossable chronic total occlusions treated percutaneously in our cath. Tornus catheter was used to penetrate and eventually cross the chronic total occlusion segment. Procedure success was defined when Tornus penetrated at least partly into chronic total occlusion segment making possible the subsequent balloon dilatation and stent implantation achieving a final TIMI III angiographic result with residual stenosis less than 30%. Switch to other microcatheter was considered as an unsuccessful procedure. Complications associated with the Tornus use were analyzed in order to evaluate device safety. RESULTS: The average age of patients was 65.2 ± 9.6 and 11 out of 14 (78.6%) were male. In 7 (50%) cases, Tornus was used after an unsuccessful balloon passage through occluded segment. In 11 (78.6%) out of 14 cases the procedure was successful and in 3 (21.4%) cases, the operator switched to another microcatheter to continue with the procedure. No complication occurred during all procedures. CONCLUSION: Tornus catheter can be effectively and safely used in a subgroup of patients undergoing percutaneous coronary intervention of chronic total occlusion with hard or balloon-uncrossable lesions and could facilitate the treatment of this type of lesions.
Keywords
- Sianos G, Werner GS, Galassi AR, Papafaklis MI, Escaned J, Hildick-Smith D, et al. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 2012; 8(1): 139-45.
- Kahn JK. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am Heart J 1993; 126(3 Pt 1): 561-4.
- Safian RD, McCabe CH, Sipperly ME, McKay RG, Baim DS. Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses. Am J Cardiol 1988; 61(14): 23G-8G.
- Delacretaz E, Meier B. Therapeutic strategy with total coronary artery occlusions. Am J Cardiol 1997; 79(2): 185-7.
- Srinivas VS, Brooks MM, Detre KM, King SB 3rd, Jacobs AK, Johnston J, et al. Contemporary percutaneous coronary intervention versus balloon angioplasty for multivessel coronary artery disease: a comparison of the National Heart, Lung and Blood Institute Dynamic Registry and the Bypass Angioplasty Revascularization Investigation (BARI) study. Circulation 2002; 106(13): 1627-33.
- Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol 2001; 38(2): 409-14.
- Hoye A, van Domburg RT, Sonnenschein K, Serruys PW. Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002. Eur Heart J 2005; 26(24): 2630-6.
- Aziz S, Stables RH, Grayson AD, Perry RA, Ramsdale DR. Percutaneous coronary intervention for chronic total occlusions: improved survival for patients with successful revascularization compared to a failed procedure. Catheter Cardiovasc Interv 2007; 70(1): 15-20.
- Surmely JF, Katoh O, Tsuchikane E, Nasu K, Suzuki T. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv 2007; 69(6): 826-32.
- Surmely JF, Tsuchikane E, Katoh O, Nishida Y, Nakayama M, Nakamura S, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol 2006; 18(7): 334-8.
- Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes DR Jr. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol 2007; 49(15): 1611-8.
- Stone GW, Reifart NJ, Moussa I, Hoye A, Cox DA, Colombo A, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part II. Circulation 2005; 112(16): 2530-7.
- Soon KH, Selvanayagam JB, Cox N, Kelly AM, Bell KW, Lim YL. Percutaneous revascularization of chronic total occlusions: review of the role of invasive and non-invasive imaging modalities. Int J Cardiol 2007; 116(1): 1-6.
- Tsuchikane E, Katoh O, Shimogami M, Ito T,
- Ehara M, Sato H, et al. First clinical experience of a novel penetration catheter for patients with severe coronary artery stenosis. Catheter Cardiovasc Interv 2005; 65(3): 368-73.
- Reifart N, Enayat D, Giokoglu K. A novel penetration catheter (Tornus) as bail-out device after balloon failure to recanalise long, old calcified chronic occlusions. EuroIntervention 2008; 3(5): 617-21.
- Ochiai M. Technical options for uncrossable lesions. In: Dangas GD, Mehran R, Moses J, Editors. Handbook of chronic total occlusions. New York, NY: CRC Press; 2007. p. 59-75.
- Fujita S, Tamai H, Kyo E, Kosuga K, Hata T, Okada M, et al. New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty: the anchor technique. Catheter Cardiovasc Interv 2003; 59(4): 482-8.
- Takahashi S, Saito S, Tanaka S, Miyashita Y, Shiono T, Arai F, et al. New method to increase a backup support of a 6 French guiding coronary catheter. Catheter Cardiovasc Interv 2004; 63(4): 452-6.
- Fang HY, Fang CY, Hussein H, Hsueh SK, Yang CH, Chen CJ, et al. Can a penetration catheter (Tornus) substitute traditional rotational atherectomy for recanalizing chronic total occlusions? Int Heart J 2010; 51(3): 147-52.
- Galassi AR. Antegrade technique (a case with oriented approach). In: Percutaneous coronary interventions for chronic total occlusions; Galassi's tips and tricks. Milan: House 2008. p. 131-74.
)