title: Use of a novel crossing and re-entry system in coronary chronic total occlusions that have failed standard crossing techniques: results of the FAST-CTOs (Facilitated Antegrade Steering Technique in Chronic Total Occlusions) trial.
abstract: OBJECTIVE
  This study sought to examine the efficacy and safety of 3 novel devices to recanalize coronary chronic total occlusions (CTOs).
  
  
  BACKGROUND
  Successful percutaneous coronary intervention (PCI) of CTOs improves clinical outcome in appropriately selected patients. CTO PCI success, however, remains suboptimal.
  
  
  METHODS
  A new crossing catheter and re-entry system was evaluated in a prospective, multicenter, single-arm trial of CTO lesions refractory to standard PCI techniques. The primary efficacy endpoint was the frequency of true lumen guidewire placement distal to the CTO (technical success).
  
  
  RESULTS
  Enrollment included 147 patients with 150 CTOs. The mean lesion length was 41 ± 17 mm. A crossing catheter crossed 56 lesions into the distal true lumen, and a re-entry catheter facilitated tapered-wire cannulation of the distal lumen in 59 CTOs initially crossed subintimally (77% technical success). Success in the first 75 CTOs was 67%, rising to 87% in the last 75 CTOs. Mean fluoroscopy and procedure times were 45 ± 16 min and 90 ± 12 min, respectively, each significantly shorter than in historical controls (p < 0.0001 for both). Coronary perforation occurred in 14 cases (9.3%), requiring treatment in 3 cases (prolonged balloon inflation, with additional coil embolization in 1 case). No tamponade or hemodynamic instability occurred. Six patients had periprocedural non-ST-segment elevation myocardial infarction. No emergency surgery, ST-segment elevation myocardial infarction, or cardiac reintervention occurred. Two deaths occurred within 30 days, neither as a direct result of the procedure. The 30-day major adverse cardiac event rate was 4.8%.
  
  
  CONCLUSIONS
  In CTOs failing standard techniques, use of a new crossing and re-entry system results in a high success rate without increasing complications.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA. whitlop@ccf.org
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Whitlow
authors.forename: M Nicholas
authors.initials: MN
authors.lastname: Burke
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Richard R
authors.initials: RR
authors.lastname: Heuser
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057785:Catheters; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D019233:Retreatment; D013997:Time Factors; D017211:Treatment Failure; D014481:United States