Author + information
- Kazeen Abdullah1,
- Ehrin Armstrong2,
- Haekyung Jeon-Slaughter3,
- Nicolas W. Shammas4,
- Khusrow Niazi5,
- Scott Kinlay6,
- Mazen Abu-Fadel7,
- Anand Prasad8,
- Houman Khalili3,
- Bala Ramanan9 and
- Emmanouil Brilakis10
- 1UTSW, dallas, Texas, United States
- 2University of Colorado, Denver, Colorado, United States
- 3University of Texas Southwestern Medical Center, Dallas, Texas, United States
- 4Midwest Cardiovascular Research Foundation, Davenport, Iowa, United States
- 5Emory University, Atlanta, Georgia, United States
- 6VA Boston Healthcare System; Brigham and Women's Hospital, Boston, Massachusetts, United States
- 7University of Oklahoma HSC, Oklahoma City, Oklahoma, United States
- 8UT Health San Antonio, San Antonio, Texas, United States
- 9University of Texas Southwestern Medical Center; VA North Texas Health Care System, Dallas, Texas, United States
- 10Minneapolis Heart Institute, UT Southwestern Medical Center/VA North Texas Health Care System, Minneapolis, Minnesota, United States
Chronic total occlusions (CTO) account for 40-50% of peripheral artery disease lesions. Several approaches are used for CTOs including wire catheter and crossing device based techniques. This study evaluated the practice patterns of crossing devices in a real world registry and technical/procedural success of various crossing devices. (Viance, Crosser, TruPath, and Frontrunner).
We analyzed data from the Excellence in PAD (XLPAD) registry between 2005-2016. We included all patients in which crossing devices were used to cross CTO lesions. We studied clinical records including lesion characteristics and procedural information. Primary endpoints were defined as procedural and technical success.
Of 1366 CTO procedures, 31% (n=425) used crossing device to cross CTO lesions. 90% of these CTO lesions were femoropopliteal and 10% were below the knee. Crossing devices were used as the initial approach in 57%, while in 43% its use was provisional after an initial catheter-wire approach. The most common crossing device was Viance (46%), followed by Frontrunner (27%), TruPath (14%), and Crosser (13%). Table 1 presents patient and clinical characteristics by crossing device. There was no significant association between crossing device types and procedural complications or procedural success rates for femoropopliteal (FP) or below the knee (BTK) CTOs. Compared with all other crossing devices, technical success rate for FP lesions was significantly higher with Viance (91%, p=0.04). There was no difference in technical success rates by crossing device type in BTK CTOs.
|Table 1. Clinical characteristics by crossing device||Viance (n=196)||TruPath (n=59)||Frontrunner (n=115)||Crosser (n=56)|
|Sex (Males)||171 (87%)||52 (88%)||110 (96%)||41 (73%)|
|Age (Years)||65±10||67±11||63±9||68 ± 9&,$|
|Race/ethnicity White||120 (61%)||40 (68%)||74 (65%)||50 (89%)|
|Black||44 (22%)||10 (17%)||36 (32%)||3 (5.5%)|
|Hispanic||11 (6%)||9 (15%)||4 (3%)||3 (5.5%)|
|Rutherford class (1-6)||3.3 ±0.8 €||3.0± 0.9||3.2±0.8||3.3±0.9‰|
|CLI presentation||50 (26%)||11 (18%)||22 (19%)||14 (25%)|
Note. & Crosser > Viance; $ Crosser > Frontrunner; € Viance >Turepath; ‼ Viance >frontrunner; § Truepath > Frontrunner; ‰Crosser > Truepath; P < 0.05 was set a statistical significance and 2-sided t-test was conducted for a paired comparison.
In a real world, multicenter registry we showed that crossing devices were used approximately 1/3rd of the time to cross infrainguinal CTOs. Viance, the most frequently used crossing device also had the highest technical success compared with all other devices for FP CTO, while there was no difference in BTK CTO lesions.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention