title: Comparative Assessment of Guidewire and Microcatheter vs a Crossing Device-Based Strategy to Traverse Infrainguinal Peripheral Artery Chronic Total Occlusions.
abstract: OBJECTIVE
  To compare success rates of a guidewire and microcatheter strategy vs the use of specialized crossing devices to traverse infrainguinal peripheral artery chronic total occlusions (CTOs).
  
  
  METHODS
  For this analysis, data on 438 consecutive infrainguinal CTO interventions in 438 patients (mean age 63.2 years; 402 men) performed between August 2006 and May 2014 were extracted from the multicenter Excellence in Peripheral Artery Disease (XLPAD) database (ClinicalTrials.gov; identifier NCT01904851). Primary technical success constituted placement of a guidewire in the true lumen, past the distal CTO cap, with the initial crossing strategy.
  
  
  RESULTS
  A wire-catheter strategy was used in 295 (67.4%) and a specialized CTO crossing device in 143 (32.6%) patients (p<0.001). Primary crossing technical success was higher with CTO devices (72.1% vs 51.9%, p<0.001). The primary wire-catheter arm used significantly more secondary CTO devices (28.1% vs 17.5%) and/or provisional re-entry devices (26.7% vs 4.9%) compared with the primary CTO device arm (both p<0.001). Secondary crossing technical success (defined as crossing with an alternate strategy: 67.5% vs 71.4%, p=1.000), provisional crossing technical success (defined as use of a re-entry device: 84.2% vs 87.5%, p=0.768), and procedure success (93.6% vs 90.9%, p=0.332) were similar between the wire-catheter and CTO device strategies, respectively. No differences were observed in periprocedural complications or 30-day adverse events; however, at 12 months, there was a significantly higher surgical revascularization rate in the primary wire-catheter arm (8.8% vs 2.8%, p=0.025).
  
  
  CONCLUSIONS
  Infrainguinal peripheral artery CTO crossing is frequently attempted with a wire-catheter technique; however, an initial CTO crossing device approach is associated with higher primary technical success. Overall procedure success is similar with both strategies.
authors.affiliation: Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA subhash.banerjee@va.gov.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Veteran Affairs North Texas Healthcare System, Dallas, TX, USA.
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Apurva
authors.initials: A
authors.lastname: Patel
authors.affiliation: Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Roosha
authors.initials: R
authors.lastname: Parikh
authors.affiliation: VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Shirling
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Midwest Cardiovascular Research Foundation, Davenport, IA, USA.
authors.forename: Nicolas W
authors.initials: NW
authors.lastname: Shammas
authors.affiliation: Veteran Affairs North Texas Healthcare System, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002404:Catheterization; D015897:Comorbidity; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D000925:Anticoagulants
keywords: anterior tibial artery; chronic total occlusion; crossing device; endovascular procedures; guidewire; microcatheter; occlusion; peripheral artery disease; peroneal artery; popliteal artery; posterior tibial artery; stenosis; superficial femoral artery