Laser wire for crossing chronic total occlusions: "learning phase" results from the U.S. TOTAL trial. Total Occlusion Trial With Angioplasty by Using a Laser Wire

Catheterization and Cardiovascular Diagnosis
S N OesterleJ J Popma

Abstract

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" pilo...Continue Reading

Associated Clinical Trials

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Citations

Oct 27, 2004·Circulation Journal : Official Journal of the Japanese Circulation Society·Shigenori ItoMakoto Itoh
Mar 25, 2005·Journal of Interventional Cardiology·Shaohong DongYonathan Hasin
May 29, 1999·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·A W Heldman, J A Brinker
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Nov 15, 2008·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Issam D Moussa
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Oct 9, 2001·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·H CorderoR R Heuser

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