Laser wire for crossing chronic total occlusions: “Learning phase” results from the U.S. TOTAL trial
✍ Scribed by Oesterle, Stephen N. ;Bittl, John A. ;Leon, Martin B. ;Hamburger, Jaap ;Tcheng, James E. ;Litvack, Frank ;Margolis, James ;Gilmore, Paul ;Madsen, Ronald ;Holmes, David ;Moses, Jeffrey ;Cohen, Howard ;King, Spencer ;Brinker, Jeffrey ;Hale, Terence ;Geraci, Dean J. ;Kerker, William J. ;Popma, Jeffrey ;,
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 274 KB
- Volume
- 44
- Category
- Article
- ISSN
- 0098-6569
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✦ Synopsis
The Prima laser guidewire system (Spectranectics Corp., Colorado Springs, CO) consists of an 0.018" hypotube containing a bundle of 45-microm optical fibers coupled to a pulsed excimer laser operating at a tip fluence of 60 ml/mm2 and a repetition rate ranging from 25-40 Hz. This laser guidewire was specifically designed to cross total occlusions refractory to passage with conventional wires. The Prima wire was evaluated in a feasibility study at 15 U.S. centers. Following failure to cross a total occlusion with approved guidewires, the Prima wire was utilized in 179 patients. Average age of subjects was 61 yr. Lesion locations included left anterior descending (36%), right (45%), and circumflex (19%) coronary arteries. Mean angiographic age of total occlusions was 70 wk (range, 2-1,020 wk, median, 14 wk). The use of the Prima wire either solely or in combination with conventional guidewires resulted in successful crossing in 61% of these previously impenetrable occlusions. Failure of the device was commonly related to length of the occlusion and tortuosity along the occluded pathway. Major complications included myocardial infarction in 7 patients (3.9%), tamponade in 3 (1.7%), and death in 2 (1.1%). This "learning phase" pilot study confirmed the feasibility of a laser guidewire in chronic total occlusions that are resistant to passage of conventional guidewires. An extended registry at these investigative sites is planned.