title: A novel approach to facilitating balloon crossing chronic total occlusions: the "wire-cutting" technique.
abstract: BACKGROUND
  Following successful guidewire passage, inability to cross the occluded lesion with a balloon is the most common cause of procedural failure for percutaneous recanalization of chronic total occlusions (CTOs). We sought to evaluate the efficacy of "wire-cutting" technique for facilitating the balloon passage through the lesion during CTO-percutaneous coronary intervention.
  
  
  METHODS
  Sixteen consecutive patients with CTOs were treated by "wire-cutting" technique when a lubricious balloon could not be passed through the lesion after successful guidewire crossing. The main process of the "wire-cutting" technique involved: inserting 2 percutaneous transluminal coronary angioplasty (PTCA) guidewires (A and B) into the distal true lumen; advancing a balloon over guidewire A to the site of the occlusion abutting the proximal cap, the balloon was then inflated and guidewire B was pressed between the balloon and the proximal cap; rapidly withdrawing guidewire B produced a cutting power that crushed the proximal cap thus facilitating balloon crossing. Technique success was defined as balloon having crossed CTO lesions successfully after performing wire-cutting procedure.
  
  
  RESULTS
  Both technical success and procedural success were obtained in 10 (62.5%) cases. Technique failure occurred in 6 (37.5%) cases, of which 2 were due to the inability to place a second guidewire into the distal true lumen and the other 4 were due to severe coronary calcification. Of these 4 failures, 2 have final procedure success with the use of Rotablator and the remaining 2 patients were referred for bypass surgery. Major complication included severe coronary dissection that occurred in 1 (6.3%) patient, which was successfully treated by stenting. No other complications were observed.
  
  
  CONCLUSIONS
  The wire-cutting technique may be considered as a simple and effective approach for facilitating balloon crossing resistant CTO lesions.
authors.affiliation: Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha city, Hunan province, China.
authors.forename: Xin-Qun
authors.initials: XQ
authors.lastname: Hu
authors.forename: Liang
authors.initials: L
authors.lastname: Tang
authors.forename: Sheng-Hua
authors.initials: SH
authors.lastname: Zhou
authors.forename: Zhen-Fei
authors.initials: ZF
authors.lastname: Fang
authors.forename: Xiang-Qian
authors.initials: XQ
authors.lastname: Shen
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy; D054059:Coronary Occlusion / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome