Recanalization of total coronary occlusions using a laser guidewire (the European TOTAL Surveillance Study).
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.
Hamburger
J N
JN
Department of Coronary Diagnostics and Intervention, Thoraxcentre, Academic Hospital Dijkzigt, Rotterdam, The Netherlands.
Serruys
P W
PW
Scabra-Gomes
R
R
Simon
R
R
Koolen
J J
JJ
Fleck
E
E
Mathey
D
D
Sievert
H
H
Rutsch
W
W
Buchwald
A
A
Marco
J
J
Al-Kasab
S M
SM
Pizulli
L
L
Hamm
C
C
Corcos
T
T
Reifart
N
N
Hanrath
P
P
Taeymans
Y
Y
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