Developments in Coronary Chronic Total Occlusion PCIs
Developments in Coronary Chronic Total Occlusion PCIs
Sakakura et al performed an autopsy study of 95 CTO lesions from 82 patients. The main findings were that negative remodeling of the CTO body was frequent and its frequency increased with increasing CTO duration. Furthermore, microchannels (>200 μm in diameter) were very rare, in contrast to previous pathology studies, which included fewer subjects and often subtotal occlusions. Hence, the current thinking that soft polymer jacketed guidewires, such as the Fielder XT wire by Asahi Intecc, are successful due to passage through microchannels is not corroborated. Another finding that supports the increasing use of the retrograde approach in CTO PCI was the more frequent tapering of the distal cap as compared to the proximal cap (79% vs 50%; P<.001).
Pathology of CTOs
Sakakura et al performed an autopsy study of 95 CTO lesions from 82 patients. The main findings were that negative remodeling of the CTO body was frequent and its frequency increased with increasing CTO duration. Furthermore, microchannels (>200 μm in diameter) were very rare, in contrast to previous pathology studies, which included fewer subjects and often subtotal occlusions. Hence, the current thinking that soft polymer jacketed guidewires, such as the Fielder XT wire by Asahi Intecc, are successful due to passage through microchannels is not corroborated. Another finding that supports the increasing use of the retrograde approach in CTO PCI was the more frequent tapering of the distal cap as compared to the proximal cap (79% vs 50%; P<.001).
