Vibrational angioplasty and hydrophilic guidewires in the treatment of chronic total coronary occlusions.

PURPOSE: To study the efficacy and safety of vibrational angioplasty versus hydrophilic guidewires for recanalizing chronic total occlusions (CTOs) of the coronary arteries. METHODS: In a retrospective study, 99 patients with old (>3 months) CTOs resistant to conventional techniques were treated either with vibrational angioplasty (group A, n = 72) or 0.014-inch hydrophilic guidewires (group B, n = 27). The selection of the technique (vibrational angioplasty or hydrophylic guidewires) was dependent only upon device availability. A variety of guidewires were employed in conjunction with vibrational angioplasty. RESULTS: The crossing success rates in groups A and B were 86.1% (62/72) and 55.5% (15/27) (p < 0.05), with final procedural success rates of 75% (54/72) and 44.4% (12/27) (p < 0.01), respectively. The main reasons for failure were inability to cross the lesion with a guidewire (10/18 in group A and 12/15 in group B) and large dissections resulting in vessel closure (2/18 in group A and 2/15 in group B). Three major complications were seen, 2 in group A and 1 in group B. Three vessel perforations were reported in group A. Both techniques needed prolonged fluoroscopy times. CONCLUSIONS: Vibrational angioplasty was more successful in treating CTOs compared to hydrophilic guidewires and had similar complication rates (most without clinical sequelae).

The use of soft and flexible guidewires in the treatment of chronic total coronary occlusions by activated guidewire angioplasty.

Activated guidewire angioplasty (AGA) is a new technique which has been designed to assist in angioplasty of total occlusions. The purpose of this study was to determine the safety and efficacy of using flexible relatively soft guidewires (floppy wires) in conjunction with this technique and also to determine the predictors of lesion crossing and final success by this technique in patients with chronic total coronary occlusions. 73 patients with 73 chronic total coronary occlusions in whom coronary angioplasty using conventional techniques had failed were treated with AGA using floppy guidewires. The success of crossing these lesions was 65.7% (48/73) resulting in a final angioplasty success of 56.1% (41/73). Angioplasty success was reduced compared with crossing success in seven arteries in which complications occurred during balloon angioplasty. Multiple stepwise logistic regression analysis identified the location of the occlusion (right coronary artery, p = 0.005) as independent predictor of crossing success of this technique and the male gender (p = 0.03), the duration of occlusion (p = 0.05), the lesion length (p = 0.01) and the location of the occlusion (right coronary artery, p = 0.02) as independent predictors of final procedural success of the method.

Use of vibrational angioplasty for the treatment of chronic total coronary occlusions: preliminary results.

The aim of the study was to investigate the feasibility and clinical safety of vibrational angioplasty in the treatment of chronic total coronary occlusions and evaluate the clinical and angiographic factors that are predictive of the procedural success and complications of the procedure. Seventy-eight patients with chronic total occlusions (>3 months) resistant to conventional techniques were treated by vibrational angioplasty using a variety of conventional guidewires. Lesions were successfully crossed in 67 (85.9%) cases and antegrade flow was achieved in 59 (75.5%). Major complications (myocardial infarction and tamponade) occurred in two (2.5%) patients, but no fatalities ensued. Angiographically detectable dissections were seen in 23 (29.5%) patients but only resulted in vessel compromise and reclosure in 5 cases. Multiple stepwise logistic regression analysis identified the duration (<6 months, P = 0.008) and the length of the occlusion (<15 mm, P = 0.03) as independent predictors of final success and the age of the patient (<55 years, P = 0.006) as the only independent predictor of procedural complications. Vibrational angioplasty is a safe technique useful in the treatment of chronic coronary occlusive disease. Patients in whom the procedure is likely to prove most successful may be easily identified by clinical and angiographic features (duration and length of occlusion).