Probe angioplasty of total coronary occlusion using the Probing Catheter technique

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. A new technique was therefore prospectively evaluated for PTCA of these lesions using the ultra-low-profile Probe "balloon on a wire" device. An intracoronary Probing Catheter was used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe into the obstruction for balloon dilatation. This technique was utilized in 64 consecutive patients with "absolute" coronary occlusions demonstrating no angiographically detectable antegrade coronary flow. Successful dilatation was achieved in 47 (73%). Among 33 occlusions of less than 3 mo duration 31 (94%) were successfully dilated whereas only 16 of 31 more chronic occlusions were dilated (P less than .01). Chronic occlusions with a tapered morphology and those located more than 1 cm from a branch point were more frequently dilatable. There were no serious complications including no vessel perforations with this technique. The Probing Catheter technique offers a safe and effective method for the dilatation of recent coronary occlusions by using balloon on a wire technology.     

Probe™ angioplasty of total coronary occlusion using the probing catheter™ technique

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. A new technique was therefore prospectively evaluated for PTCA of these lesions using the ultra-low-profile Probe? “balloon on a wire” device. An intracoronary Probing Catheter? was used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe? Into the obstruction for balloon dilatation. This technique was utilized in 64 consecutive patients with “absolute” coronary occlusions demonstrating no angiographically detectable antegrade coronary flow. Successful dilatation was achieved in 47 (73%). Among 33 occlusions of less than 3 mo duration 31 (94%) were successfully dilated whereas only 16 of 31 more chronic occlusions were dilated (P<.01). Chronic occlusions with a tapered morphology and those located more than 1 cm from a branch point were more frequently dilatable. There were no Serious complications including no vessel perforations with this technique. The Probing Catheter? technique offers a safe and effective method for the dilatation of recent coronary occlusions by using balloon on a wire technology.     

Probe angioplasty of total coronary occlusion using an intracoronary probing catheter™

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. We have therefore developed a technique for PTCA of chronic total coronary occlusions using the ultralow profile “balloon-on-a-wire” Probe?. An intracoronary Probing Catheter? is used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe into the obstruction for balloon dilatation. This technique was used in 13 patients including six in whom other dilating systems had failed to cross the occlusion. Successful dilatation was performed in nine patients (67%). Among the six patients in whom other dilating systems had failed, dilatation was performed in five using the Probing Catheter technique with a successful outcome acieved in four (67%). The Probing Catheter technique offers a promising new method to apply “balloon-on-a-wire” technology to the dilatation of chronic total coronary occlusions. This method may allow successful dilatation when other dilating systems fail.     

Probe angioplasty of total coronary occlusion using an intracoronary Probing Catheter

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. We have therefore developed a technique for PTCA of chronic total coronary occlusions using the ultralow profile "balloon-on-a-wire" Probe. An intracoronary Probing Catheter is used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe into the obstruction for balloon dilatation. This technique was used in 13 patients including six in whom other dilating systems had failed to cross the occlusion. Successful dilatation was performed in nine patients (67%). Among the six patients in whom other dilating systems had failed, dilatation was performed in five using the Probing Catheter technique with a successful outcome achieved in four (67%). The Probing Catheter technique offers a promising new method to apply "balloon-on-a-wire" technology to the dilatation of chronic total coronary occlusions. This method may allow successful dilatation when other dilating systems fail.     

Successful Recanalization Using a Hydrophilic-Coated Guide Wire in Total Coronary Occlusions After Unsuccessful PTCA Attempts with Standard Steerable Guide Wires

During a balloon angioplasty procedure, cardiac interventionalists frequently have difficulty passing standard guide wires into coronary arteries with chronic total occlusion. In the past year, we encountered eight patients with occluded coronary arteries where standard guide wires were tried (average duration 15.5 minutes) but were unsuccessful. Application of a 0.025–0.035-inch hydrophilic guide wire was then attempted and was successful in recanalizing seven of the eight coronary occlusions (average duration 3.9 minutes). The channel created by the hydrophilic guide wire remained patent after its removal and permitted subsequent balloon angioplasty to be performed. Thus, in some patients with coronary occlusion where difficulty in guide wire passage is encountered, the application of a hydrophilic guide wire for crossing the occlusion and facilitating PTCA should be considered. However, a larger clinical series will be needed to determine the safety and efficacy of this technique.     

Percutaneous transluminal coronary angioplasty in a patient with Kawasaki disease. A case report of an unsuccessful angioplasty.

A 13-year-old boy with severe coronary stenosis due to Kawasaki disease underwent percutaneous transluminal coronary angioplasty (PTCA). The guide wire and the balloon catheter easily passed through the stenosis in the left anterior descending artery. However, effective dilatation could not be achieved even when the balloon size was increased to 2.5 mm in diameter. We discontinued further inflation of the balloon because serious resistance was encountered on withdrawal of the balloon catheter. In patients with Kawasaki disease, the value of PTCA as a treatment for coronary stenosis is questionable.     

Preliminary experience with 5 and 6 French diagnostic catheters as guiding catheters for coronary angioplasty

With the reduction in profile of balloon dilation catheters, until recently, it has been the internal dimensions and performance of the guiding catheter that has mandated the use of 7, 8 or 9 French (F) systems for the performance of percutaneous transluminal coronary angioplasty (PTCA). A new 5F catheter design (Sherwood Medical Co., St. Louis, MO) provided a large inner lumen (0.4") permitting use of 0.20-0.22" fixed-wire PTCA balloon catheters with good coronary visualization. Potential advantages include reduced coronary artery ostial trauma and catheter induced damping and enhanced patient comfort. We report our initial experience in 14 patients undergoing PTCA with a 5 and 6F guide/fixed-wire system. Mean age was 63 +/- 10 (43-78 years). PTCA indications: Cardiogenic shock (1), post-myocardial infarction angina pectoris (2), grade III angina (5) and unstable angina pectoris (6). Vessel attempted: Left anterior descending (3), circumflex (4), obtuse marginal (2), diagonal (1), right coronary artery (3), and internal thoracic artery (1). Twelve patients had femoral approach; two brachial approach. The USCI Probe (USCI Division, Billerica, MA) was used in 8 lesions and SCIMED ACE (SCIMED Life Systems, Maplegrove, MN) catheter in 7 lesions. Successful 5 or 6F guide/fixed-wire dilations reduced the stenosis (77 +/- 14 to 37 +/- 30%) and were successfully performed in 79% (11/14). One 5F patient required 8F guiding catheter and was dilated with 2.0 fixed-wire balloon. A second failed 5F PTCA could not be dilated with any larger conventional system. A third total occlusion could not be crossed with a guidewire or fixed wire balloon. No patient had a complication.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnum Meier wires with Crag Fx wire catheter for total occlusive coronary arteries

Magnum Meier wire was used with Crag Fx wire catheter instead of Magnum balloon catheter to facilitate wire crossing through total occlusion by improving flexibility of the system without losing wire pushability. Of 372 coronary angioplasty procedures performed between January 1994 and April 1995, there were 12 subacute occlusions with an interval of 3 wk or less and 30 chronic occlusions with an interval of >3 wk. Regular over-the-wire-type balloon catheters failed to dilate four subacute occlusions and nine chronic total occlusions. Magnum Meier wire with Crag Fx wire catheter was tried for one subacute occlusion and four chronic occlusions that were undilatable with a regular balloon system and successfully dilated the subacute occlusion and three of the chronic occlusions. The lesions successfully dilated by this new approach were either long or tandem lesions in vessels that were excessively tortuous or showed an acute angle at the orifice. Thus the Magnum Meier wire with Crag Fx wire catheter can be a useful tool for dilating totally occluded lesions in tortuous coronary arteries. Cathet. Cardiovasc. Diagn. 40:198–201, 1997. © 1997 Wiley-Liss, Inc.     

Review of Hardware for PTCA

There is a growing inventory of dilatation hardware at the disposal of the interventional cardiologist. The purpose of this review is to compare the distinguishing features of current and anticipated equipment which should be considered in the selection of hardware for performing coronary angioplasty (PTCA). New guiding catheters designed to improve "back-up" support for difficult anatomic variants include the hockey stick, the El Gamal, the Arani, the FR 3.5 ALT, and the AL 0.75 and ALR 1.2 Amplatz models. New "micro" dilatation catheters include the Mini-Profile and Skinny catheters, which combine independent wire movement and low profile shafts (3.5 F), and the Probe, which is currently the catheter with the lowest profile shaft (1.7 F) and balloon (0.020" for a 2.0-mm diameter balloon). The low profile of the Probe allows it to be used alongside a conventional 4.3 F dilatation catheter within the new 9 F Giant Lumen guiding catheter, which has an internal diameter of 0.088". The forthcoming "monorail" catheters will provide the operator with a low profile, "over-the-wire" system that can be exchanged for a different balloon size or a perfusion catheter without using an extension or exchange wire. Two innovations in guidewire technology are the Dilating Guide Wire (DGW) and the Buchbinder Om-niflex catheter. The DGW features a 1.5-mm diameter balloon with a deflated profile of 0.018" that can be accommodated within the Trac and Trac Plus series of dilatation catheters. The Buchbinder Omniflex catheter is designed so that the distal tip of the wire can be rotated and flexed via controls on the proximal hub of the catheter, permitting shaping of the tip without removal of the catheter. Selection of appropriate equipment from the vast array of PTCA hardware will allow the operator to minimize the cost and maximize both the safety and success of dilating a coronary stenosis. (J Interven Cardiol 1988:1:3)     

Subselective Intracoronary Access Guide Catheters for use with the ProbeTM Balloon on a Wire Coronary Dilatation Device

Subselective coronary access guide catheters are described for use with the Probe^TM balloon on a wire coronary dilatation device. These access catheters provide the following advantages over the "naked" Probe^TM: (1) Guide catheter stabilization, (2) Lesion access, (3) Lesion visualization, (4) Lesion crossing, and (5) Lesion protection. The Probe/access catheter system was used in 51 patients on 132 lesions (average 2.6 lesions/patient; range 1–8 lesions/patient) of which 116 (88%) were dilated successfully. Failures tended to be in total occlusions or in eccentric subtotal occlusions that could not be crossed with the Probe^TM tip wire. No patient required emergency coronary bypass. One patient sustained a small myocardial infarction within 24 hours of the procedure. One patient developed hemopericardium after rupture of a small branch coronary artery. One patient died from intracerebral bleeding due to thrombolytic and anticoagulant therapy. The Probe^TM access catheter system has several advantages over the Probe^TM device alone, and future developments can be expected to extend these benefits. (J Inter-ven Cardiol 1989:2:1)     

Early clinical experience with a hot tip laser wire in patients with chronic coronary artery occlusions

Chronic coronary artery occlusions remain one of the problems limiting the use of percutaneous transluminal coronary angioplasty (PTCA). We have studied the use of an 0.018 inch laser hot tip wire. It was coupled either to a continuous wave argon or Nd-YAG laser generator and introduced through a balloon catheter to try and cross and dilate a series of chronic coronary artery occlusions in which initial conventional attempts had failed. Four LAD and 6 RCA occlusions were attempted; we successfully crossed and dilated 6 (60%) lesions, 4 (40%) using the laser wire alone to recanalize the occlusion and in 2 a combination of laser wire and conventional means.     

Recanalization of chronic total coronary arterial occlusions by percutaneous excimer-laser and laser-assisted angioplasty

A low primary success and high restenosis rate after recanalization of chronic total occlusions by conventional coronary angioplasty have encouraged the application of new interventional techniques like excimer-laser angioplasty. In 39 patients with a coronary occlusion for 1 to 12 months, recanalization was attempted by laser angioplasty through a multifiber-catheter coupled to a pulsed XeCl excimer laser. After successful passage of the occlusion by a standard guidewire in 27 patients (69%), the laser catheter was advanced over the central guidewire and crossed the occlusion in 25 patients (64%). In 2 patients with unsuccessful passage of the laser catheter, the subsequent attempt with a low profile balloon catheter also failed. In 19 of the 25 patients with successful laser recanalization, the residual stenosis exceeded 50% and was therefore followed by additional balloon angioplasty. The average residual stenosis after laser was 61 +/- 17% of the vessel diameter, and after balloon angioplasty 28 +/- 9% (n = 19), whereas after laser angioplasty alone it was 38 +/- 5% (n = 6). No complications associated with the laser application were observed. Angiographic control after 24 hours showed a reocclusion of 2 (8%) recanalized vessels. In this pilot study, laser angioplasty proved to be a safe and feasible method for the treatment of chronic total coronary occlusions. Because it was necessary to guide the catheter by a central wire, the primary success was limited by a successful passage of the wire of the occlusion. The rate of stand-alone laser angioplasty has to be increased by future improvements of the technique to enable a comparative evaluation of this method with conventional angioplasty.     

Probe exchange catheter used for angioplasty of total coronary artery occlusions

Percutaneous transluminal coronary angioplasty (PTCA) for total occlusions frequently fails, because the guidewire fails to pass the occlusion. With the use of the Probe exchange catheter (PEC), however, stiffness of the guidewire is increased and a higher pushability is obtained in order to manipulate the guidewire beyond the lesion. Once the guidewire has passed, the PEC is advanced and a non-over-the-wire dilatation catheter can be introduced through the PEC. This paper describes the technique in a representative case. The results of this technique in 19 consecutive patients with class III-IV/IV(NYHA) angina due to an occluded coronary artery are presented. In 16 patients the PEC reached the lesion (84%) and in all these patients the guidewire could pass the occlusion. A successful PTCA was performed in 14 patients (74%).     

First clinical experience of a novel penetration catheter for patients with severe coronary artery stenosis.

The study aimed to evaluate the efficacy of a novel penetration catheter for severe coronary artery disease. Severe coronary artery diseases such as chronic total occlusions or severe calcified stenoses sometimes obstruct the subsequent crossing of balloon catheter after successful wire crossing. A novel penetration over-the-wire catheter has been developed for severe coronary artery disease. The main shaft is a coreless stainless coil that consists of eight stranded stainless wires to cross through a severe stenosis by manual rotation. This device was applied during percutaneous coronary intervention for patients with severe coronary artery disease obstructing the subsequent crossing of balloon or microcatheters after successful wire crossing. Initial results were examined. Fourteen eligible patients were enrolled consecutively. Among those, 10 patients had chronic total occlusion and 7 patients showed severe angiographical calcification. The device was successfully crossed through the lesion and enabled subsequent dilatation in all patients without any complication. This new device enables the crossing of severe coronary artery stenoses and therefore favors further dilatation in this lesion subset.     

Parallel angioplasty dilatation catheter and guide wire: A new technique for the dilatation of calcified coronary arteries

Percutaneous transluminal coronary angioplasty (PTCA) of heavily calcified rigid coronary arteries has decreased success and increased complication rates. Three cases are presented describing a new technique for the dilatation of severely calcified coronary arteries that were not dilatable by conventional angioplasty methods. This technique involves the use of a balloon dilatation catheter system parallel to a guide wire. © 1993 Wiley-Liss, Inc.     

Two years experience of the use of a penetration catheter (Tornus) recanalization during percutaneous coronary interventions on chronic total occlusions

We included in this study 43 patients chronic total occlusions (CTO) subjected percutaneous coronary interventions (PCI) with the use of penetration catheter (Tornus) in 2009-2010. Penetration catheter was applied only in those cases when it was not possible to introduce low profile coronary dilatation catheter into the site of occlusion. After penetration of CTO by a guide wire a channel was formed by a manually rotated penetration catheter. The Tornus catheter was successfully passed into distal part of an artery in 81.4% of cases. In other.     

Recanalization of chronic coronary occlusions using a laser wire

Between August, 1993–December, 1994, recanalization of a chronically occluded coronary artery was attempted in 412 patients, with an overall success rate of 77%. The main reason for failure was subintimal tracking of the guide wire. However, in 13 patients, advancing the guide wire was not possible either subintimally or in the former true lumen. In 8 of these 13 patients with failed conventional recanalization, a second attempt was made using a 0.018′ laser wire. The suspected occlusion duration was 6 wk–6 yr, and the occlusion length 6–21 mm. Successful crossing of the occlusion was achieved in 7 of 8 patients. One patient experienced pericardial hematoma without severe clinical consequences. Adjunctive conventional laser angioplasty and/or balloon dilatation led to a residual stenosis of <50% in 7 patients. The laser wire technique may become an important new method for recanalizing chronic total coronary occlusions in selected patients. © 1996 Wiley-Liss, Inc.     

The use of an exchange guide wire in coronary angioplasty

Of 84 consecutive patients referred for coronary angioplasty, an exchange length (260 cm) guide wire was used in 17 (20%) to allow serial passage of different sized dilatation catheters. Exchanges were performed for the following reasons: 1) inability to cross the stenotic segment with a full-sized dilatation catheter, with exchange for a smaller catheter to permit initial dilatation followed by a second exchange to reintroduce the full-sized balloon catheter; 2) premeditated initial use of a low-profile balloon catheter in severe stenosis, with subsequent exchange to a full-sized balloon catheter; 3) inability to achieve a satisfactory reduction of the transstenotic gradient or angiographic stenosis with the initial dilation catheter, requiring subsequent passage of a larger balloon catheter into the partially dilated segment. Eighteen of 19 attempted exchanges and 18 of 19 angioplasty procedures were completed successfully. The use of exchange guide wires permits multiple recrossings of a dilated segment, allows safe serial passage of different sized balloon catheters, and obviates the need for renegotiating difficult proximal coronary anatomy. The exchange guide wire techique can be applied safely and effectively to coronary angioplasty and provides an additional option in the successful completion of movable guide wire angioplasty procedures.     

Use of a hollow wire to facilitate angioplasty of occluded vessels.

An USCI 0.038 inch (0.97 mm) floppy tipped hollow wire was used to facilitate the passage of angioplasty guide wires across severe stenoses or vessel occlusions before balloon angioplasty. The hollow wire was passed through a standard 7 or 8 French gauge Judkins coronary catheter to establish whether the obstruction could be breached. This reduced the cost of failure because angioplasty guiding systems were not committed to procedures that were unlikely to be successful. The hollow wire provides stability for the passage of the guide wire and can be used to measure distal pressure and inject contrast. To date it has been used in a total of 15 cases of occluded vessels; it failed to cross the lesion in four cases. Successful angioplasty followed in all patients in whom the lesion was crossed.     

Use of a hollow wire to facilitate angioplasty of occluded vessels

An USCI 0.038 inch (0.97 mm) floppy tipped hollow wire was used to facilitate the passage of angioplasty guide wires across severe stenoses or vessel occlusions before balloon angioplasty. The hollow wire was passed through a standard 7 or 8 French gauge Judkins coronary catheter to establish whether the obstruction could be breached. This reduced the cost of failure because angioplasty guiding systems were not committed to procedures that were unlikely to be successful. The hollow wire provides stability for the passage of the guide wire and can be used to measure distal pressure and inject contrast. To date it has been used in a total of 15 cases of occluded vessels; it failed to cross the lesion in four cases. Successful angioplasty followed in all patients in whom the lesion was crossed.