Recanalization of chronic total peripheral arterial occlusions using optical coherent reflectometry with guided radiofrequency energy: a single center experience.
BACKGROUND
A forward-looking, fiberoptic guided device (Safe-Cross System, Intraluminal Therapeutics, Carlsbad, CA) has been used with guided radiofrequency energy to open chronic total occlusions (CTOs). This report describes the use of optical coherent reflectometry (OCR) system to assess safety and efficacy of opening CTOs in native peripheral arteries in the lower extremities: iliac, femoral, and popliteal.


METHODS
18 CTOs in native peripheral arteries in 17 patients were treated with OCR after failed attempts with conventional wires (minimum 10 min of fluoroscopic time). When the CTO was crossed, routine angioplasty with or without stent was performed. Efficacy was defined as achievement of distal lumen position. Safety was defined as device success without perforation, dissection (> or =Grade C), or distal embolization. The mean patient age was 72 years with 8 females and 10 males. Lesion characteristics included a mean vessel diameter of 5.8 mm and a mean lesion length of 22.4 cm. Ankle-brachial indices was < or =0.8 in all patients.


RESULTS
The OCR system was successful in crossing 100% of the CTOs in patients that failed conventional wire crossing, whereas clinical success occurred in 94% of these patients. Complications consisted of a single dissection > or =Grade C. No perforations or distal embolization occurred.


CONCLUSIONS
The Safe-Cross OCR System is both efficacious and safe in the treatment of CTOs that failed crossing with conventional wires and indirect visualization of the intraluminal position by using OCR technology appears to minimize vessel trauma, dissection, perforation, and distal embolization.
Kirvaitis
Romas J
RJ
Phoenix Heart Center, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Phoenix, AZ 85013, USA.
Parr
Luke
L
Kelly
Lisa M
LM
Reese
Amber
A
Kamineni
Raghunandan
R
Heuser
Richard R
RR
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D017115:Catheter Ablation; D002908:Chronic Disease; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D055095:Optics and Photonics; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012107:Research Design; D015607:Stents; D016896:Treatment Outcome