HOW TO SELECT CORONARY WIRE FOR ANTEGRADE RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS

Aim. To define principles of coronary wire choice during coronary artery chronic total occlusion (CTO) recanalization by antegrade approach.

Material and methods. From 2009 to 2013 the attempt of coronary artery CTO recanalization by antegrade approach was undertaken for 217 patients. Depending on success of CTO crossing by coronary wire patients were divided into 2 groups: group 1 (n=164) - successful wire crossing, group 2 (n=53) -unsuccessful attempt of CTO recanalization by coronary wire.

Results. In the group 2 there were more frequent CTO localization in the right coronary artery (p<0,05 as compared to group 1), presence of blunt stump, higher frequency of side branches in the zone of proximal CTO cup, and large CTO length (p<0,001 as compared to group 1). CTO recanalization in 47% cases begun from soft wire with polymeric coating and tapered tip, successful recanalization by these wire type was achieved in 49,02% patients. Using non-tapered tip intermediate stiffness wire as the first choice wire was associated with the failure of recanalization (p=0,0440 in intergroup comparison). At impossibility of CTO recanalization by soft wire with polymeric coating and tapered tip used as a first choice, it replacement on non-tapered tip intermediate stiffness wire allowed to achieve successful recanalization in 36,67% patients. In the cases of this strategy uneffectiveness using stiff wire with polymeric coating and tapered tip as a third choice allowed additionally to attain successful recanalization in 60% cases. Replacement of the soft wire with polymeric coating and tapered tip on stiff wire with polymeric coating and tapered tip, executable at presence of meaningful rigidity in the proximal CTO cup zone associated with the achievement the successful recanalization in 60% cases.

Conclusion. On the basis of the obtained data it was created the conception of step-up wire stiffness increase during the CTO recanalization by antegrade approach.

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