Does intraluminal blunt microdissection allow successful crossing and revascularization in patients with coronary chronic total occlusions refractory to guidewire techniques?
Intraluminal blunt microdissection provides a feasible and successful alternative approach for crossing coronary chronic total occlusions when standard guidewire techniques fail.
This study describes a new approach to crossing coronary chronic total occlusions using controlled blunt microdissection and its successful application to coronary angioplasty in three patients. After guidewire techniques failed to cross the occlusions, the blunt intraluminal microdissection catheter was deployed. Actuation of a hinged jaw on the catheter distal assembly created a channel for the guidewire through the diseased segment, in the true lumen (a right coronary and a left circumflex artery) and subintimally (a circumflex artery), to allow angioplasty and stenting. Coronary circulation improved from TIMI grade 0 to 3. Angina was relieved in all three cases. Subsequent angiography for two cases, 2 and 19 months after PTCA, respectively, showed restored flow and patent stented regions.
Whitbourn et al. (Mon,) studied this question.
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