Author + information
- Received October 9, 2017
- Revision received October 15, 2017
- Accepted October 19, 2017
- Published online February 5, 2018.
- Judit Karacsonyi, MDa,b,
- Peter Tajti, MDb,c,
- Bavana V. Rangan, BDS, MPHa,
- Sean C. Halligan, MDd,
- Raymond H. Allen, MDd,
- William J. Nicholson, MDe,
- James E. Harvey, MD, MSce,
- Anthony J. Spaedy, MDf,
- Farouc A. Jaffer, MD, PhDg,
- J. Aaron Grantham, MDh,
- Adam Salisbury, MDh,
- Anthony J. Hart, MDh,
- David M. Safley, MDh,
- William L. Lombardi, MDi,
- Ravi Hira, MDi,
- Creighton Don, MDi,
- James M. McCabe, MDi,
- M. Nicholas Burke, MDc,
- Khaldoon Alaswad, MDj,
- Gerald C. Koenig, MD, PhDj,
- Kintur A. Sanghvi, MDk,
- Daniel Ice, MDk,
- Richard C. Kovach, MDk,
- Vincent Varghese, DOk,
- Bilal Murad, MDl,
- Kenneth W. Baran, MDl,
- Erica Resendes, MSa,
- Jose R. Martinez-Parachini, MDa,m,
- Aris Karatasakis, MDa,
- Barbara A. Danek, MDa,
- Rahel Iwnetu, MDa,
- Michele Roesle, RN, BSNa,
- Houman Khalili, MDa,
- Subhash Banerjee, MDa and
- Emmanouil S. Brilakis, MD, PhDa,c,∗ ()
- aDepartment of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
- bDepartment of Cardiovascular Diseases, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
- cDepartment of Cardiovascular Diseases, Minneapolis Heart Institute, Minneapolis, Minnesota
- dDepartment of Cardiovascular Diseases, North Central Heart/Avera Heart Hospital, Sioux Falls, South Dakota
- eDepartment of Cardiovascular Diseases, York Hospital–Wellspan Health System, York, Pennsylvania
- fDepartment of Cardiovascular Diseases, Missouri Heart Center, Columbia, Missouri
- gDepartment of Cardiovascular Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- hDepartment of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas, Missouri
- iDepartment of Cardiovascular Diseases, University of Washington, Seattle, Washington
- jDepartment of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan
- kDepartment of Cardiovascular Diseases, Deborah Heart and Lung Center, Browns Mills, New Jersey
- lDepartment of Cardiovascular Diseases, United Heart and Vascular Clinic, Saint Paul, Minnesota
- mDepartment of Cardiovascular Diseases, Oklahoma University Medical Center, Oklahoma City, Oklahoma
- ↵∗Address for correspondence:
Dr. Emmanouil S. Brilakis, Minneapolis Heart Institute, 920 East 28th Street #300, Minneapolis, Minnesota 55407.
Objectives The authors performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions.
Background There is equipoise about the optimal initial strategy for crossing coronary chronic total occlusions.
Methods The primary endpoints were the time required to cross the chronic total occlusion or abort the procedure and the frequency of procedural major adverse cardiovascular events. The secondary endpoints were technical and procedural success, total procedure time, fluoroscopy time required to cross and total fluoroscopy time, total air kerma radiation dose, total contrast volume, and equipment use.
Results Between 2015 and 2017, 246 patients were randomized to the CrossBoss catheter (n = 122) or wire escalation (n = 124) at 11 U.S. centers. The baseline clinical and angiographic characteristics of the study groups were similar. Technical and procedural success were 87.8% and 84.1%, respectively, and were similar in the 2 groups. Crossing time was similar: 56 min (interquartile range: 33 to 93 min) in the CrossBoss group and 66 min (interquartile range: 36 to 105 min) in the wire escalation group (p = 0.323), as was as the incidence of procedural major adverse cardiovascular events (3.28% vs. 4.03%; p = 1.000). There were no significant differences in the secondary study endpoints.
Conclusions As compared with wire escalation, upfront use of the CrossBoss catheter for antegrade crossing of coronary chronic total occlusions was associated with similar crossing time, similar success and complication rates, and similar equipment use and cost.
- antegrade dissection/re-entry
- antegrade wire escalation
- chronic total occlusion
- percutaneous coronary intervention
This work was supported by a research grant from Boston Scientific. Dr. Rangan has received research grant support from InfraReDx and Spectranetics. Dr. Halligan has received consulting fees from Abbott Vascular and Boston Scientific. Dr. Nicholson has served on the advisory board and Speakers Bureau as well as a proctor for Abbott Vascular, Boston Scientific, Asahi Intecc, and Medtronic; and has served as a proctor and consultant for and owns intellectual property in Vascular Solutions. Dr. Harvey has served as a consultant and on the advisory board for Boston Scientific. Dr. Spaedy has served as a consultant for Abbott Vascular, Medtronic, and Boston Scientific. Dr. Jaffer has served as a consultant for Abbott Vascular and Boston Scientific; and has received research grant support from Canon, Siemens, and the National Institutes of Health. Dr. Grantham has received research grant support from and served on the advisory board for Boston Scientific; has received speaking fees and honoraria from Boston Scientific and Abbott Vascular; and is a part-time employee of and owns equity in Corindus. Dr. Salisbury has received research grant support from Boston Scientific and Gilead. Dr. Hira has served as a consultant for Abbott Vascular. Dr. Lombardi owns equity in BridgePoint Medical. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and has served as a consultant for Abbott Laboratories. Dr. Murad has served as a proctor for CTO PCI for Boston Scientific. Dr. Banerjee has received research grant support from Gilead and The Medicines Company; has received institutional research grants from Boston Scientific and Merck; has received consultant and speaker honoraria from Covidien, Gore, Janssen, AstraZeneca, Cardiovascular Systems, Inc., and Medtronic; and has ownership in MDCARE Global (spouse) and intellectual property in HygeiaTel. Dr. Brilakis has received consulting and speaker honoraria from Abbott Vascular, Amgen, Asahi, Cardiovascular Systems, Inc., Elsevier, GE Healthcare, and Medicure; has received research grant support from Boston Scientific and Osprey; and his spouse was an employee of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 9, 2017.
- Revision received October 15, 2017.
- Accepted October 19, 2017.
- 2018 American College of Cardiology Foundation