title: Comparison of magnetic wire navigation with the conventional wire technique for percutaneous coronary intervention of chronic total occlusions: a randomised, controlled study.
abstract: Wire crossing of a chronic total coronary occlusion (CTO) is time consuming and limited by the amount of contrast agent and time of radiation exposure. Magnetic wire navigation (MWN) might accelerate wire crossing by maintaining a coaxial vessel orientation. This study compares MWN with the conventional approach for recanalization of CTOs. Forty symptomatic patients with CTO were randomised to MWN (n = 20) or conventional approach (n = 20) for antegrade crossing of the occlusion. In the intention-to-treat analysis, MWN showed a shorter crossing time (412 versus 1131 s; p = 0.001), and, consequently, lower usage of contrast agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation exposure (dose-area product: 29 versus 80 Gy*cm(2); p = 0.002) during wire crossing compared to the conventional approach. Accordingly, in the per-protocol analysis, the wire-crossing rate was, in trend, higher using the conventional approach (17 of 31) compared to MWN (9 of 28; p = 0.08). The use of MWN for revascularisation of CTOs is feasible and reduces crossing time, use of contrast agent, and radiation exposure. However, due to a broader selection of wires, the conventional approach enables wire crossing in cases failed by MWN and seems to be the more successful choice.
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Roth
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria. rudolf.berger@meduniwien.ac.at.|Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Eisenstadt, Austria. rudolf.berger@meduniwien.ac.at.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Scherzer
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Lisa
authors.initials: L
authors.lastname: Krenn
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Gangl
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dalos
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.|Department of Internal Medicine IV, Cardiology, Hospital of Hietzing, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Delle-Karth
authors.affiliation: Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.|Department of Internal Medicine I, Cardiology, University Hospital of Krems, Krems an der Donau, Austria.|Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neunteufl
mesh_terms: D000368:Aged; D001317:Austria; D002908:Chronic Disease; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Chronic total occlusion (CTO); Complex lesions; Contrast media; Coronary artery disease (CAD); Revascularization