Improvement of the primary success rate of recanalization of chronic total coronary occlusions with the Safe-Cross system after failed conventional wire attempts.

BACKGROUND: In view of the improved long-term patency with drug-eluting stents, the challenge with chronic total coronary occlusion (CTO) remains the low primary success rate. Improved guide wires have increased this rate, but alternative devices may be of additional value. The goal of the present study was to determine the additional benefit of a new penetration device in CTOs after an extensive conventional wire approach. METHODS AND
RESULTS: In 148 consecutive patients the recanalization of a CTO of >3 months was attempted. A conventional wire approach was used with recent dedicated recanalization wires, which was successful in 104 patients (70%). If after at least 20 min of fluoroscopic time no crossing of the wire was achieved, the Safe-Cross wire (SC) (Intralumina) was used which enables verification of the intraluminal wire position via optical reflectometry, and crossing of resistent occlusion caps by radiofrequency ablation. Due to severe dissections after the conventional approach, the SC was not used in 10 patients. In 34 patients the SC wire was applied, leading to successful lesion crossing in 14 patients (41%). Thus, the primary success rate was improved from 70.2% to 79.7%. No periprocedural major adverse events were observed with the SC wire. The successful attempts with the SC wire were predominantly in blunt occlusions. All patients with successful wire passage could be treated with one or more stents.
CONCLUSIONS: In a real world cohort of patients with CTO, the SC wire could increase the primary success rate after failed extensive conventional wire attempt. In these worst case patients the SC success rate was 41%. This new wire appears to have additional potential in failures of a conventional wire approach.