title: Antegrade wire escalation for chronic total occlusions in coronary arteries: simple algorithms as a key to success.
abstract: OBJECTIVE
  Antegrade wire escalation (AWE) remains the method of choice for tackling chronic total occlusions (CTOs), especially for lesions with low J-CTO score. To increase the number of operators which treat CTOs and increase AWE success rates, there is a need for a clear, algorithmic approach. We report the results of a simple AWE algorithm with new guidewire technology in coronary CTOs.
  
  
  METHODS
  Hundred consecutive CTO lesions selected for AWE as the primary strategy were included in five Benelux centers. The algorithm follows a step-wise increase in guidewire tip load. Lesions were categorized according to the J-CTO score. Primary endpoint was successful guidewire crossing.
  
  
  RESULTS
  No differences in baseline demographics were present between successful and unsuccessful procedures. Overall, in 75% of the lesions AWE resulted in successful crossing. AWE success rates in easy, intermediate, difficult and very difficult CTOs were 83, 86, 71 and 43%, respectively. 46% could be crossed using a soft guidewire only. An additional success of 34 and 60% could be reached with an intermediate and stiff guidewire, respectively. Adding additional techniques resulted in 88% overall success. Procedure and fluoroscopy times, radiation doses and use of contrast were within highly acceptable ranges (67 ± 39 min, 27 ± 19 min, 1.7 ± 1.3 Gy, 264 ± 123 ml).
  
  
  CONCLUSIONS
  The algorithm and new wire technologies led to high success rates. AWE as a standalone procedure is highly successful in J-CTO 0-1. Low- and intermediate-volume CTO operators should try to implement a systematic approach in their CTO procedures, especially for lesions with low J-CTO scores. Adding additional techniques further increases these success rates.
authors.affiliation: aFaculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium bDepartment of Cardiology, VU University Medical Center, Amsterdam, The Netherlands cDepartment of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium dDepartment of Cardiology, l'Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg City, Luxembourg eDepartment of Cardiology, Onze-Lieve-Vrouwe Ziekenhuis Aalst, Aalst, Belgium fDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Joren
authors.initials: J
authors.lastname: Maeremans
authors.forename: Paul
authors.initials: P
authors.lastname: Knaapen
authors.forename: Wynand J
authors.initials: WJ
authors.lastname: Stuijfzand
authors.forename: Peter
authors.initials: P
authors.lastname: Kayaert
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.forename: Jo
authors.initials: J
authors.lastname: Dens
mesh_terms: D000368:Aged; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome