title: Efficient distal tip size of primary guidewire for antegrade percutaneous coronary intervention in chronic total occlusion: The G-FORCE study.
abstract: BACKGROUND
  Although several new techniques have been introduced for CTO such as the retrograde approach, the fundamental question of what type of guidewire is the most appropriate as a primary guidewire in the antegrade approach has not been answered.
  
  
  METHODS
  The G-FORCE study was designed as a prospective multicenter randomized controlled trial to determine the efficient primary guidewire in antegrade approach for chronic total occlusion (CTO). The first guidewire was randomly assigned to a regular size distal tip group (0.014in. size) or tapered tip group (0.010in. or less). The primary endpoint was defined as successful lesion penetration by the first guidewire into distal true lumen. This study was registered at ClinicalTrials.gov with identifier NCT00987610.
  
  
  RESULTS
  A total of 260 patients were enrolled, with an average age of 66±11years and 16% were female. The average J-CTO score was 1.8±1.1. The primary endpoint was achieved in 38% and 32% of patients using tapered and regular distal tip guidewires, respectively (P=0.80). The final PCI success rate was 81% vs. 85%, respectively (P=0.57). Easy CTO lesions with a J-CTO score=0 exhibited a primary endpoint significantly different between tapered and regular distal tip primary guidewires (79% vs. 40%; P=0.046). Guidewire distal coating or distal tip load did not relate with primary guidewire success rate.
  
  
  CONCLUSIONS
  Tapered and regular distal tip guidewires are equivalent as a first choice for CTO. Tapered guidewires are superior for CTO lesions with a J-CTO score=0.
authors.affiliation: Tokai University School of Medicine, Isehara, Japan. Electronic address: ikari@is.icc.u-tokai.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ikari
authors.affiliation: Kansai Rosai Hospital, Amagasaki, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Awata
authors.affiliation: Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.affiliation: Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.affiliation: Kansai Rosai Hospital, Amagasaki, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Tokai University School of Medicine, Isehara, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Fujii
authors.affiliation: University of Tokyo, Tokyo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.affiliation: Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.affiliation: Jichi Medical University, Shimotsuke, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Ikemoto
authors.affiliation: Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.affiliation: Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.affiliation: Iwate Prefectual Central Hospital, Morioka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Mie Heart Center, Mie, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Nishikawa
authors.affiliation: Akita Medical Center, Akita, Japan.
authors.forename: Tadaya
authors.initials: T
authors.lastname: Sato
authors.affiliation: Tenri Hospital, Tenri, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
mesh_terms: D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D004867:Equipment Design / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Chronic total occlusion; Clinical trials; Coronary artery disease; Percutaneous coronary intervention