Case History A 61-year-old male with no history of infarct, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) presented with stable CCS II angina.

Through angiography, a 20 mm chronic total occlusion (CTO) was noted in the proximal to mid left anterior descending (LAD), with retrograde filling from the right coronary artery (RCA) (Figure 1). The patient was hypertensive, had hypercholesterolemia and a positive stress test. The decision was made to attempt to navigate through the LAD CTO with the Crosser Catheter System (FlowCardia, Inc., Sunnyvale, CA) using high frequency mechanical recanalization.

Interventional Procedure
A 6 Fr, XB 3.5 guide catheter was introduced into the left coronary artery and the Crosser catheter was delivered primary to the LAD occlusion over a .014” Asahi Intermediate guide wire (Nagoya, Japan). The Crosser was activated for approximately 2 minutes when the device appeared to be following a subintimal track (Figure 2). After additional device activation, the device was confirmed to be in the true lumen and the bend in the artery gave the appearance of subintimal progress (Figure 3). The Crosser catheter was activated for a total of four minutes, allowing for guide wire placement in the true distal lumen. The Crosser was then withdrawn and a 1.5 mm x 20 mm Maverick® balloon catheter (Boston Scientific, Maple Grove, MN) was used to predilate the recanalized CTO. Subsequently, a 2.5 mm x 20 mm Maverick was used to dilate the lesion and a 3.0 mm x 28 mm CoStar™ paclitaxel stent (Biotronik AG, Berlin, Germany) was delivered for a good final result (Figure 4).

Discussion
In this case, the Crosser catheter proved successful for recanalization of a chronic total occlusion with mid-CTO tortuosity. The case illustrates the ability of the device to navigate a tortuous path of the occlusion within the true lumen without arterial dissection or perforation. The tip of the Crosser catheter mechanically vibrates against the face of the CTO at 20,000 cycles per second (20kHz). This high-frequency, low-amplitude longitudinal stroke provides mechanical impact and cavitational effects, which aid in safe recanalization of an occluded artery. Safe and extremely easy to use, interventionalists may find the “Crosser First” technique more advantageous to avoid dissections often caused by guidewire probing and manipulation at the face of the CTO.

Laura Minarsch can be contacted at euromed@ix.netcom.com