Angioplasty for Chronic Total Occlusion by UsingTapered-Tip Guidewires

Shigeru Saito,* MD, Shinji Tanaka, MD, Yoshitaka Hiroe, MD, Yusuke Miyashita, MD, Saeko Takahashi, MD, Shutaro Satake, MD, and Kazushi Tanaka, MD

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still technically challenging. The use of tapered-tip guidewires in these lesions may improve the success rate of PCI. In order to avoid the needless radiation exposure or contrast consumption, we have to determine a guideline for the termination of procedures in these lesions. We retrospectively analyzed the data of 182 patients between April 1997 and December 1999 (phase 1) and 80 patients between January and August 2001 (phase 2) who underwent angioplasty for CTO lesions ≥ 3 months. There were no significant differences in clinical or lesion characteristics except the use of tapered-tip guidewires. Tapered-tip guidewires were used in 60% of patients in phase 2 period but no patients in phase 1 period. The overall success rate of PCI was improved from 67% in phase 1 to 81% in phase 2 (P  0.019). In the phase 2 period, the success rate was higher in tapered-type occlusion (P  0.002) and shorter length of occlusion (P  0.004). Total procedure time was 46  17 min and total volume of contrast dye was 180  63 ml. The success rate was higher in patients treated by transradial coronary intervention (TRI) than transfemoral coronary intervention (89% vs. 64%; P  0.008). The use of tapered-tip guidewires can improve the success rate of PCI in CTO lesions. The following guideline for the termination of the procedures is reasonable: time from arterial access to successful penetration of a guidewire through occlusion ≤ 30 min; total procedure time ≤ 90 min; and total dye volume ≤ 300 ml. TRI can achieve a high success rate even in CTO lesions provided that the case selection is adequate. Cathet Cardiovasc Intervent 2003; 59:305–311. © 2003 Wiley-Liss, Inc.

Key words: double-guidewire technique; contralateral dye injection; transradial coronary intervention

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