title: New re-entry device for revascularization of chronic coronary total occlusions: preliminary single Japanese center experience.
abstract: BACKGROUND
  Although retrograde approach for coronary chronic total occlusion (CTO) has been introduced, the procedure is still time and resource consuming. A simplified antegrade approach mightbe another resort. The aim of this study was to evaluate a new device designed to facilitate guidewire re-entry into the true lumen of a CTO from the adjacent subintimal space.
  
  
  METHODS
  Patients with CTO were entered into a prospective registry regardless of lesion characteristics. A new metal-tip catheter was used initially in primary use cases. If it created subintimal tracking, a new re-entry tool (a flat balloon with 2 exit ports offset by 180 degrees) was used as a platform to attempt guidewire penetration into the distal true lumen. In rescue use cases after unsuccessful conventional wiring, the re-entry procedure was subsequently attempted.
  
  
  RESULTS
  In 11 CTO lesions attempted, device success was achieved in 8 cases (72.7%). Re-entry procedure success rate was higher in primary use cases (80%) compared to rescue use cases (33.3%). Retrograde approach was conducted immediately after unsuccessful antegrade procedure using this device in the other 3 cases and successful recanalization was achieved in all cases. All lesions were stented, resulting in TIMI 3 flow without major complications.
  
  
  CONCLUSIONS
  A new coronary re-entry device may provide another strategic option in the antegrade approach to recanalize CTOs.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyama, Toyohashi, Aichi, 441-8530, Japan. dokincha@aioros.ocn.ne.jp
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
authors.forename: Maoto
authors.initials: M
authors.lastname: Habara
authors.forename: Tairo
authors.initials: T
authors.lastname: Kurita
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ito
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D062906:Cardiac Catheters / Q000592:standards / Q000639:trends; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design / Q000639:trends; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods; D008297:Male; D008422:Materials Testing / Q000706:statistics & numerical data; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012042:Registries; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency