CLINICAL EVENTS CALENDAR
- StartMar 07,2010EndMar 12,2010Interventional Cardiology 2010: 25th Annual International Symposium: The Silvertree Hotel, Snowmass Village, COtinyurl.com/mg5olq
- StartMar 14,2010EndMar 16,2010American College of Cardiology Scientific Session and i2 Summit 2010: Atlanta, GAacc.org
- StartMar 22,2010EndMar 26,2010Baylor University and Hankamer School of Business present: The 4th annual Global Business Forumhttp://www.baylor.edu/business/international/
- StartMar 25,2010EndMar 26,2010Balancing Your Own Health While Caring for Patients: Cocoa, FL (accredited)www.thegoldenlights.com
Crosser Catheter used Primarily to Treat Proximal LAD Chronic Total Occlusion
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 The Crosser was then withdrawn and a 1.5 mm x 20 mm Maverick® balloon catheter (Boston Scientific, Maple Grove, MN) was used to predilate the recanalized CTO.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 laura22@mmc-medical.com
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Center for Education & Practice Development - Learning Module Femoral Artery Sheath Management(PDF) This learning module is designed for the Registered Nurse Division 1 working in areas where
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