Author + information
It has been reported that microchannels are present inside chronic total occlusions (CTOs), and soft guidewires with a tip diameter less than 0.014 inch (Slender-GW) are considered suitable for negotiating them.
Eighty-five CTOs treated by a single operator between January 2008 and April 2010 were reviewed. For 28 of them, “microchannelography” (McG) was performed to reveal microchannels. The McG was provided with tip injections using a microcatheter, the tip of which was placed at the proximal of the CTO. Following McG, a Slender-GW was used as the initial guidewire, but was exchanged for a CTO-dedicated guidewire such as one in the Confienza series when the Slender-GW failed to cross the lesion.
The McG findings were classified into 3 categories: grade 0, without identifiable microchannels; grade 1, with microchannels only in the proximal part; grade 2, with microchannels throughout the CTO. Grades 0, 1, and 2 were observed in 9, 9, and 10 of the CTO, respectively. Patient and lesion characteristics were comparable between the 3 McG grades. For grades 1 and 2, Slender-GWs crossed the lesion in all cases except for one of grade 1. In 5 cases of grade 0, a Confienza Pro guidewire was successful in crossing the lesion when the Slender-GW could not penetrate it, and penetration was unsuccessful in 3 cases. Therefore, Slender-GW success rates were 11.1%, 88.8%, and 100% for grade 0, 1, and 2, respectively (P<0.001).
The presence of microchannels was evaluated with McG. McG may be helpful in selecting the guidewire for CTO-PCI.
- 2013 American College of Cardiology Foundation