title: Recanalization of total coronary occlusions using a laser guidewire (the European TOTAL Surveillance Study).
abstract: The success rates of coronary angioplasty for the treatment of chronic total occlusions are less favorable than for coronary stenosis. Therefore, a new laser guidewire (LW) was designed to facilitate the crossing of chronic total occlusions. We report on the results of a European multicenter surveillance study, evaluating the laser guidewire performance. Between May 1994 and July 1996, 345 patients (age 59 +/- 10 years, 291 men) with chronic total occlusions were enrolled in 28 European centers. The median age of occlusion was 29 weeks (range 2 to 884), the occlusion length 19 +/- 10 mm. LW recanalization was successful in 205 patients (59%/). LW perforation occurred in 73 patients (21%), with hemodynamic consequences in 4 (1%). There were no deaths, emergency coronary artery bypass graft surgery, or Q-wave myocardial infarctions. In a multivariate regression analysis an occlusion age of <40 weeks (p = 0.001, RR = 1.34) and an occlusion length <30 mm (p = 0.01, RR = 1.59) were independent predictors of success. Results indicate that the LW is an effective and safe tool in the treatment of chronic total occlusion refractory to conventional guidewires.
authors.affiliation: Department of Coronary Diagnostics and Intervention, Thoraxcentre, Academic Hospital Dijkzigt, Rotterdam, The Netherlands.
authors.forename: J N
authors.initials: JN
authors.lastname: Hamburger
authors.forename: P W
authors.initials: PW
authors.lastname: Serruys
authors.forename: R
authors.initials: R
authors.lastname: Scabra-Gomes
authors.forename: R
authors.initials: R
authors.lastname: Simon
authors.forename: J J
authors.initials: JJ
authors.lastname: Koolen
authors.forename: E
authors.initials: E
authors.lastname: Fleck
authors.forename: D
authors.initials: D
authors.lastname: Mathey
authors.forename: H
authors.initials: H
authors.lastname: Sievert
authors.forename: W
authors.initials: W
authors.lastname: Rutsch
authors.forename: A
authors.initials: A
authors.lastname: Buchwald
authors.forename: J
authors.initials: J
authors.lastname: Marco
authors.forename: S M
authors.initials: SM
authors.lastname: Al-Kasab
authors.forename: L
authors.initials: L
authors.lastname: Pizulli
authors.forename: C
authors.initials: C
authors.lastname: Hamm
authors.forename: T
authors.initials: T
authors.lastname: Corcos
authors.forename: N
authors.initials: N
authors.lastname: Reifart
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
authors.forename: Y
authors.initials: Y
authors.lastname: Taeymans
mesh_terms: D002908:Chronic Disease; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome