Key result
Polymer-jacketed and stiff guidewires were the most commonly used and successful for antegrade wire escalation in CTO PCI, achieving a 63% successful wiring rate without an increase in MACE.
Observational (n=679)
Yes
In contemporary CTO PCI, polymer-jacketed and stiff guidewires are most frequently used for antegrade wire escalation and provide high crossing rates without increasing MACE or perforation.
May inform antegrade wire selection in CTO PCI; leaves open need for randomized confirmation.
OBJECTIVES: We sought to describe contemporary guidewire and microcatheter utilization for antegrade wire escalation (AWE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: Equipment utilization for AWE has been variable and evolving over time. METHODS: We examined device utilization during 694 AWE attempts in 679 patients performed at 15 experienced US centers between May 2012 and April 2015. RESULTS: Mean age was 65.6 ± 9.7 years, and 85% of the patients were men. Successful wiring occurred in 436 AWE attempts (63%). Final technical and procedural success was 91% and 89%, respectively. The mean number of guidewire types used for AWE was 2.2 ± 1.4. The most frequently used guidewire types were the Pilot 200 (Abbott Vascular, 56% of AWE procedures), Fielder XT (Asahi Intecc, 45%), and the Confianza Pro 12 (Asahi Intecc, 28%). The same guidewires were the ones that most commonly crossed the occlusion: Pilot 200 (36% of successful AWE crossings), Fielder XT (20%), and Confianza Pro 12 (11%). A microcatheter or over-the-wire balloon was used for 81% of AWE attempts; the Corsair microcatheter (Asahi Intecc) was the most commonly used (44%). No significant association was found between guidewire type and incidence of major adverse cardiac events (MACE). CONCLUSIONS: Our contemporary, multicenter CTO PCI registry demonstrates that the most commonly used wires for AWE are polymer-jacketed guidewires. "Stiff" and polymer-jacketed guidewires appear to provide high crossing rates without an increase in MACE or perforation, and may thus be considered for upfront use.
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Karatasakis et al. (2016) conducted an observational in Chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) (n=679). Antegrade wire escalation using various guidewires and microcatheters was evaluated on Successful wiring. Polymer-jacketed and stiff guidewires were the most commonly used and successful for antegrade wire escalation in CTO PCI, achieving a 63% successful wiring rate without an increase in MACE.
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