A Novel Approach to Facilitating Balloon Crossing Chronic Total Occlusions: The "Wire-Cutting" Technique

作者：Hu, Xin-Qun; Tang, Liang; Zhou, Sheng-Hua^*; Fang, Zhen-Fei; Shen, Xiang-Qian

来源：Journal of Interventional Cardiology, 2012, 25(3): 297-303.

DOI：10.1111/j.1540-8183.2012.00721.x

• OCCLUDED CORONARY-ARTERIES
• PERCUTANEOUS RECANALIZATION
• ROTATIONAL ATHERECTOMY
• PENETRATION CATHETER
• ANGIOPLASTY
• EXPERIENCE
• SUCCESS

Background: Following successful guidewire passage, inability to cross the occluded lesion with a balloon is the most common cause of procedural failure for percutaneous recanalization of chronic total occlusions (CTOs). We sought to evaluate the efficacy of wire-cutting technique for facilitating the balloon passage through the lesion during CTO-percutaneous coronary intervention. Methods: Sixteen consecutive patients with CTOs were treated by wire-cutting technique when a lubricious balloon could not be passed through the lesion after successful guidewire crossing. The main process of the wire-cutting technique involved: inserting 2 percutaneous transluminal coronary angioplasty (PTCA) guidewires (A and B) into the distal true lumen; advancing a balloon over guidewire A to the site of the occlusion abutting the proximal cap, the balloon was then inflated and guidewire B was pressed between the balloon and the proximal cap; rapidly withdrawing guidewire B produced a cutting power that crushed the proximal cap thus facilitating balloon crossing. Technique success was defined as balloon having crossed CTO lesions successfully after performing wire-cutting procedure. Results: Both technical success and procedural success were obtained in 10 (62.5%) cases. Technique failure occurred in 6 (37.5%) cases, of which 2 were due to the inability to place a second guidewire into the distal true lumen and the other 4 were due to severe coronary calcification. Of these 4 failures, 2 have final procedure success with the use of Rotablator and the remaining 2 patients were referred for bypass surgery. Major complication included severe coronary dissection that occurred in 1 (6.3%) patient, which was successfully treated by stenting. No other complications were observed. Conclusion: The wire-cutting technique may be considered as a simple and effective approach for facilitating balloon crossing resistant CTO lesions. (J Interven Cardiol 2012;25:297303)

• 出版日期2012-6
• 单位中南大学