ChoICE (TM) PT wire for recanalization of chronically occluded coronary arteries: Multiple wires in one?

Percutaneous transluminal coronary angioplasty (PTCA) of chronic total occl usions may be technically difficult and the success rate is limited despite increasing operator experience and improvements in PTCA hardware. The numb er of guidewires required to cross totally occluded lesions is higher than that for stenotic lesions. The ChoICE(TM) polymer-tip (PT) wire (Boston Sci entific/Scimed, Inc., Maple Grove, Minnesota) is a relatively new stainless -steel core wire with a hydrophilic-coated polyurethane tip. Though never d escribed in the literature, we found that the distal 4 cm of the wire can b e cut and reshaped according to the operator's needs. Thus, instead of resh aping a kinked tip or using another new wire, the former being time-consumi ng and the latter expensive, one can simply cut off the kinked tip and star t again with a "new wire". As the tip is resected, the wire becomes progres sively more "intermediate-like" and "standard-like". We report our experien ce with the ChoICE PT wire in 50 consecutive cases of chronic total occlusi ons. The cumulative crossing success rates were 13/50 (26%) before any rese ctions, 24/50 (48%) after 1 resection, 41/50 (82%) after 2 resections and 4 2/50 (84%) after 3 resections. There were no perforations, deaths, myocardi al infarctions, or need for bypass surgery. Our findings suggest that succe ssful recanalization of chronic total occlusions can be achieved with a hig h success rate using the ChoICE PT wire. A strategy of progressively resect ing the more floppy and kinked distal end can provide multiple uses from a single wire, optimizing recanalization success and obviating the need for a dditional wires.