title: Guidewire and microcatheter utilization patterns during antegrade wire escalation in chronic total occlusion percutaneous coronary intervention: Insights from a contemporary multicenter registry.
abstract: OBJECTIVE
  We sought to describe contemporary guidewire and microcatheter utilization for antegrade wire escalation (AWE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Equipment utilization for AWE has been variable and evolving over time.
  
  
  METHODS
  We examined device utilization during 694 AWE attempts in 679 patients performed at 15 experienced US centers between May 2012 and April 2015.
  
  
  RESULTS
  Mean age was 65.6 ± 9.7 years, and 85% of the patients were men. Successful wiring occurred in 436 AWE attempts (63%). Final technical and procedural success was 91% and 89%, respectively. The mean number of guidewire types used for AWE was 2.2 ± 1.4. The most frequently used guidewire types were the Pilot 200 (Abbott Vascular, 56% of AWE procedures), Fielder XT (Asahi Intecc, 45%), and the Confianza Pro 12 (Asahi Intecc, 28%). The same guidewires were the ones that most commonly crossed the occlusion: Pilot 200 (36% of successful AWE crossings), Fielder XT (20%), and Confianza Pro 12 (11%). A microcatheter or over-the-wire balloon was used for 81% of AWE attempts; the Corsair microcatheter (Asahi Intecc) was the most commonly used (44%). No significant association was found between guidewire type and incidence of major adverse cardiac events (MACE).
  
  
  CONCLUSIONS
  Our contemporary, multicenter CTO PCI registry demonstrates that the most commonly used wires for AWE are polymer-jacketed guidewires. "Stiff" and polymer-jacketed guidewires appear to provide high crossing rates without an increase in MACE or perforation, and may thus be considered for upfront use. © 2016 Wiley Periodicals, Inc.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Muhammad Nauman J
authors.initials: MN
authors.lastname: Tarar
authors.affiliation: Columbia University, New York, New York.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Henry Ford Hospital, Detroit, Michigan.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Torrance Memorial Medical Center, Torrance, California.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.affiliation: PeaceHealth St. Joseph Medical Center, Bellingham, Washington.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Mid America Heart Institute, Kansas City, Missouri.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Lembo
authors.affiliation: Columbia University, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Columbia University, New York, New York.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Columbia University, New York, New York.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.affiliation: Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Medical Center of the Rockies, Loveland, Colorado.
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.affiliation: Banner Good Samaritan Cavanagh Heart Clinic, Phoenix, Arizona.
authors.forename: Ashish
authors.initials: A
authors.lastname: Pershad
authors.affiliation: Methodist Hospital, Houston, Texas.
authors.forename: Alpesh
authors.initials: A
authors.lastname: Shah
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, California.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, San Diego, California.
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.affiliation: Providence Health Center, Waco, Texas.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Shoultz
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Danek
authors.affiliation: Boston Scientific, Natick, Massachusetts.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D062906:Cardiac Catheters / Q000706:statistics & numerical data*; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008904:Miniaturization; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation*; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: antegrade approach; chronic total occlusion; guidewires; percutaneous coronary intervention; technical success; technique