Initial experience with a hydrophilic-coated guidewire for recanalization of chronic coronary occlusions

Chronic coronary occlusions are still a therapeutic challenge to the interv entional cardiologist, New techniques such as laser wire have improved reca nalization rates, but outcomes are still far from satisfactory. We report t he results of a nonrandomized single-center investigation using a hydrophil ic-coated guidewire (Terumo Crosswire). Between September 1996 and Septembe r 1998, 107 chronic occlusions in 106 patients were approached when previou s attempts with conventional guidewires failed. Median occlusion duration i n these cases was 4 months (range, 0.5-122); mean occlusion length was 19 /- 11 mm (range, 5-60). Forty-five (42%) of these attempts were successful. Attempts were successful in 42% in the left anterior descending artery, in 30% in the left circumflex artery, in 48% in the right coronary artery, an d in 43% in coronary artery bypass grafts. Success rates ranged from 56% fo r occlusions of less than 4-month duration to 18% for occlusions of more th an 36-month duration. The success rate in TIMI 1-flow lesions was significa ntly higher than in TIMI 0 flow lesions, 85% vs, 36%. In a multivariate reg ression analysis, TIMI flow grade acid occlusion age were independent predi ctors of success. There were no deaths or Q-wave myocardial infarctions; tw o cases of hemopericardium were treated successfully, In five cases, perica rdial contrast staining due to vessel perforation occurred. Our results ind icate that the Crosswire is an effective tool in the treatment of chronic c oronary occlusions, even when recanalization attempts with conventional gui dewires fail. (C) 2000 Wiley-Liss, Inc.