title: Application of penetration device (Tornus) for percutaneous coronary intervention in balloon uncrossable chronic total occlusion-procedure outcomes, complications, and predictors of device success.
abstract: OBJECTIVE
  To evaluate procedure outcomes, complications, and the predictors of device success while using the Tornus in CTO revascularization.
  
  
  BACKGROUND
  The success of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) may be limited by the presence of severe calcified CTO lesions, especially in the smallest balloon uncrossable arteries. A penetrating device (Tornus) could improve the success rate.
  
  
  METHODS
  Device and angiographic success rates as well as procedural complications were assessed in 56 patients, who were consecutively and retrospectively enrolled into this study. Device success was defined as successful passage of the Tornus catheter through a CTO lesion. Procedure success was defined by a final TIMI 3 flow and <30% residual stenosis.
  
  
  RESULTS
  The device success rate was 71.4% in 40 patients and failure rate was 28.6% in 16 patients. The final procedure success was significantly higher in the Tornus success group compared with the Tornus failure group (87.5% vs. 37.5%, P < 0.001). One patient in the Tornus success group (1.8%) had wire perforation resulting in cardiac tamponade and cardiac death. Another patient (1.8%) in the Tornus success group had acute in-stent thrombosis and non-Q MI in 24 hr and was resuscitated by emergent PCI. The only independent predictor of device success was a calcium score < 2 (odds ratio (OR): 3.86 (95% CI: 1.14-13.1, P = 0.03).
  
  
  CONCLUSIONS
  The Tornus catheter can be used in severe calcified CTO PCI when the calcium score <2 and not be used in patients with a calcium score ≥2.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan, Republic of China.
authors.forename: Hsiu-Yu
authors.initials: HY
authors.lastname: Fang
authors.forename: Chien-Ho
authors.initials: CH
authors.lastname: Lee
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fang
authors.forename: Cheng-Jui
authors.initials: CJ
authors.lastname: Lin
authors.forename: Cheng-Ching
authors.initials: CC
authors.lastname: Wu
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Yuan-Kai
authors.initials: YK
authors.lastname: Hsieh
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057785:Catheters; D016009:Chi-Square Distribution; D002681:China; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*