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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;25:297–303)
Journal of Interventional Cardiology – Wiley
Published: Jun 1, 2012
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