title: Endoluminal treatment of peripheral chronic total occlusions using the Crosser® recanalization catheter.
abstract: OBJECTIVE
  Revascularization of lower extremity chronic total occlusions (CTOs) is technically challenging. The Crosser® recanalization catheter was designed to facilitate distal vessel intraluminal entry that is both rapid and safe. We present our experience with the Crosser device as primary therapy for peripheral CTOs.
  
  
  METHODS
  Subjects undergoing evaluation for arterial insufficiency at our institution between 2008-2010 who were noted to have a CTO in the lower extremity by duplex ultrasonography and who subsequently underwent Crosser recanalization were enrolled. Clinical characteristics, ankle-brachial indices, Rutherford-Becker symptom category, and angiographic CTO parameters were collected. Primary technical success was intraluminal delivery of the guidewire into the distal vessel solely by the Crosser device. Secondary technical success was assisted delivery using the Outback LTD® re-entry device. Safety endpoints were the occurrence of dissections, thromboembolism, and perforations related to the Crosser device. Statistical analysis was performed to find independent predictors for failure to achieve Crosser recanalization.
  
  
  RESULTS
  Fifty-six subjects with 73 CTOs were enrolled. The mean Crosser use time was 17.6 ± 12.7 minutes. The overall primary and secondary technical success rates for Crosser recanalization were 76.7% and 87.7%, respectively. Technical success was highest for CTOs located in the aorto-iliac (90.0%) and tibial (95.2%) arterial segments. There were no perforations related to the Crosser device. For successful cases, the mean ABI improved significantly from pre- to post-intervention (0.57 ± 0.13 to 0.89 ± 0.15, p < 0.001). The only predictors for failure were lesion length longer than 100 mm (p = 0.04) and calcification within 10 mm of the exit cap (p = 0.02).
  
  
  CONCLUSIONS
  The Crosser device is safe and shows excellent efficacy in facilitating guidewire distal lumen entry, especially for aorto-iliac and tibial occlusions. The technical success rate for the femoral and popliteal occlusions is comparable to those reported with other recanalization techniques.
authors: NYU Langone Medical Center, Cardiac and Vascular Institute, 550 First Avenue, New York, NY 10016 USA. cezar.staniloae@nyumc.org.
authors: Cezar S
authors: CS
authors: Staniloae
authors: Kanika P
authors: KP
authors: Mody
authors: Sidharth S
authors: SS
authors: Yadav
authors: Seol Young
authors: SY
authors: Han
authors: Ravikiran
authors: R
authors: Korabathina
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods; D055109:Ankle Brachial Index; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006305:Health Status Indicators; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010446:Peptide Fragments / Q000627:therapeutic use; D058729:Peripheral Arterial Disease / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin