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A randomized study comparing two guidewire strategies for angioplasty of chronic total coronary occlusion

2000; Elsevier BV; Volume: 85; Issue: 9 Linguagem: Inglês

10.1016/s0002-9149(00)00713-x

1879-1913

Thierry Lefèvre, Yves Louvard, Christophe Loubeyre, Pierre Dumas, J. F. Piechaud, Marek Król, A Benslimane, Rajendra Kumar Premchand, Marie‐Claude Morice,

Peripheral Artery Disease Management

Chronic total coronary occlusion is a relatively frequent 1 Myler R.K Shaw R.E Stertzer S.H Hecht H.S Ryan C Rosenblum J Cumberland D.C Murphy M.C Hansell H.N Hidalgo B Lesion morphology and coronary angioplasty current experience and analysis. J Am Coll Cardiol. 1992; 19: 1641-1652 Abstract Full Text PDF PubMed Scopus (247) Google Scholar lesion subset, and percutaneous transluminal coronary angioplasty (PTCA) in this setting is associated with lower success rates, increased costs, longer procedural duration and radiation exposure, greater use of contrast media, and higher restenosis rates 2 Holmes Jr, D.R Vlietstra R.E Reeder G.S Bresnahan J.F Smith H.C Bove A.A Schaff H.V Angioplasty in total coronary artery occlusion. J Am Coll Cardiol. 1984; 3: 845-849 Abstract Full Text PDF PubMed Scopus (131) Google Scholar , 3 Kereiakes D.J Selmon M.R McAuley B.J Mc Auley D.B Sheehan D.J Simpson J.B Angioplasty in total coronary artery occlusion:experience in 76 consecutive patients. J Am Coll Cardiol. 1985; 6: 526-533 Abstract Full Text PDF PubMed Scopus (150) Google Scholar , 4 Melchior J.P Meier B Urban P Finci L Steffenino G Noble J Rutishauser W Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlusion. Am J Cardiol. 1987; 59: 535-538 Abstract Full Text PDF PubMed Scopus (157) Google Scholar , 5 Stone G.W Rutherford B.D McConahay D.R Johnson W.L Giorgi L.V Ligon R.W Hartzler G.O Procedural outcome of angioplasty for total coronary occlusion an analysis of 971 lesions in 905 patients. J Am Coll Cardiol. 1990; 15: 849-865 Abstract Full Text PDF PubMed Scopus (215) Google Scholar , 6 Bell M.R Berger P.B Bresnahan J.F Reeder G.S Bailey K.R Holmes Jr, D.R Initial and long-term outcome of 354 patients after coronary balloon angioplasty of total coronary occlusions. Circulation. 1992; 85: 1003-1011 Crossref PubMed Scopus (196) Google Scholar , 7 Ivanhoe R.J Weintraub W.S Douglas Jr, J.S Lembo N.J Furman M Gershony G Cohen C.L King III, S.B Percutaneous transluminal coronary angioplasty of chronic total occlusions primary success, restenosis, and long-term clinical follow-up. Circulation. 1992; 85: 106-115 Crossref PubMed Scopus (300) Google Scholar , 8 Kahn J.K Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am Heart J. 1993; 126: 561-564 Abstract Full Text PDF PubMed Scopus (181) Google Scholar , 9 Delacrétaz E Meier B Therapeutic strategy with total coronary artery occlusions. Am J Cardiol. 1997; 79: 185-187 Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar compared with coronary stenosis. These limitations preclude the achievement of complete revascularization in patients with multivessel disease. For these reasons, coronary artery bypass graft surgery is frequently the first therapeutic option in patients with multivessel disease where 1 major vessel is occluded. Despite the improvements in the techniques used, the inability to cross the lesion with the guidewire remains the most frequent cause of failure. 10 Tan K Sulke N Taub N Sowton E Clinical and lesion morphologic determinants of coronary angioplasty success and complications. Current experience. J Am Coll Cardiol. 1995; 25: 855-865 Abstract Full Text PDF PubMed Scopus (179) Google Scholar New guidewires were recently developed in this setting, 11 Hosny A Lai D Mancherje C Lee G Successful recanalization using a hydrophilic-coated guidewire in total coronary occlusions after unsuccessful PTCA attempts with standard steerable guidewires. J Intervent Cardiol. 1990; 3: 225-230 Crossref Scopus (8) Google Scholar , 12 Gray D.F Sivananthan U.M Verma S.P Michalis L.K Rees M.R Balloon angioplasty of totally and subtotally occluded coronary arteries results using the hydrophilic Terumo Radifocus Guidewire M (Glidewire). Cathet Cardiovasc Diagn. 1993; 30: 293-299 Crossref PubMed Scopus (27) Google Scholar and a 0.014-in hydrophilic guide (Crosswire, Terumo, Tokyo, Japan), which was specifically designed for chronic coronary occlusion, showed encouraging preliminary results. 13 Freed M Boatman J.E Siegel N Safian R.D Grines C.K O’Neill W Glidewire treatment of resistant coronary occlusions. Cathet Cardiovasc Diagn. 1993; 30: 201-204 Crossref PubMed Scopus (16) Google Scholar , 14 Corcos T Favereau X Guérin Y Toussaint M Ouzan J Zheng H Pentousis D Recanalization of chronic coronary occlusions using a new hydrophilic guidewire. Cathet Cardiovasc Diagn. 1998; 43: 83-90 Crossref Scopus (32) Google Scholar , 15 Kinoshita I Katoh O Nariyama J Otsuji S Tateyama H Kobayashi T Shibata N Ishihara T Ohsawa N Coronary angioplasty of chronic total occlusions with bridging collateral vessels:Immediate and follow-up outcome from a large single-center experience. J Am Coll Cardiol. 1995; 26: 409-415 Abstract Full Text PDF PubMed Scopus (158) Google Scholar Consequently, after a learning curve of 50 cases, we performed a randomized study.