TCT-414 Safety and Efficacy of Dedicated Guidewire, Microcatheter, and Guide Catheter Extension Technologies for Chronic Total Coronary Occlusion Revascularization: Primary Results of the Teleflex Chronic Total Occlusion Study

Abstract

Background: Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited. Methods: A prospective, multicenter, single-arm trial was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization using specialized guidewires, microcatheters, and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events [MACE]). Results: The prevalence of diabetes was 32.7%, of prior MI was 48.0%, and of previous bypass surgery was 32.7%. Average (mean ± SD) CTO length was 46.9 ± 20.5 mm, and mean J-CTO score was 1.9 ± 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Devices used included guidewire support microcatheters in 100% and guide catheter extensions in 64.0%, and the mean number of CTO-specific guidewires per procedure was 5.11 ± 3.52. Overall, procedural success was observed in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and the rate of absence of in-hospital MACE was 80.7%. Methods included antegrade (54.0%), retrograde (1.3%), and combined antegrade and retrograde techniques (44.7%). Total mean procedure time was 149 ± 91 minutes, mean radiation dose was 2,219 ± 1,608 mGy, and mean contrast utilization was 205 ± 95 mL. Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 patients (10.7%). Conclusion: In a multicenter, prospective registration trial, favorable procedural success and early clinical outcomes were achieved in a patient population with high lesion complexity using contemporary techniques and application of dedicated CTO guidewires, microcatheters, and guide catheter extensions. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP