Author + information
- Received October 9, 2017
- Revision received October 15, 2017
- Accepted October 19, 2017
- Published online October 31, 2017.
- Judit Karacsonyi, MD1,2,
- Peter Tajti, MD2,3,
- Bavana V. Rangan, BDS, MPH1,
- Sean C. Halligan, MD4,
- Raymond H. Allen, MD4,
- William J. Nicholson, MD5,
- James E. Harvey, MD, MSc5,
- Anthony J. Spaedy, MD6,
- Farouc A. Jaffer, MD, PhD7,
- J. Aaron Grantham, MD8,
- Adam Salisbury, MD8,
- Anthony J. Hart, MD8,
- David M. Safley, MD8,
- William L. Lombardi, MD9,
- Ravi Hira, MD9,
- Creighton Don, MD9,
- James M. McCabe, MD9,
- M. Nicholas Burke, MD3,
- Khaldoon Alaswad, MD10,
- Gerald C. Koenig, MD, PhD10,
- Kintur A. Sanghvi, MD11,
- Daniel Ice, MD11,
- Richard C. Kovach, MD11,
- Vincent Varghese, DO11,
- Bilal Murad, MD12,
- Kenneth W. Baran, MD12,
- Erica Resendes, MS1,
- Jose R. Martinez-Parachini, MD1,13,
- Aris Karatasakis, MD1,
- Barbara A. Danek, MD1,
- Rahel Iwnetu, MD1,
- Michele Roesle, RN, BSN1,
- Houman Khalili, MD1,
- Subhash Banerjee, MD1 and
- Emmanouil S. Brilakis, MD, PhD1,3,∗ ()
- 1VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX
- 2Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
- 3Minneapolis Heart Institute, Minneapolis, MN
- 4North Central Heart/ Avera Heart Hospital, Sioux Falls, SD
- 5York Hospital - Wellspan Health System, York PA
- 6Missouri Heart Center, Columbia, MO
- 7Massachusetts General Hospital and Harvard Medical School, Boston, MA
- 8St. Luke's Mid America Heart Institute, Kansas, MO
- 9University of Washington, Seattle, WA
- 10Henry Ford Hospital, Detroit, MI
- 11Deborah Heart and Lung Center, Browns Mills, NJ
- 12United Heart and Vascular Clinic, Saint Paul, MN
- 13Oklahoma University Medical Center, Oklahoma City, OK
- ↵∗Correspondence to: Emmanouil S. Brilakis, MD, PhD Minneapolis Heart Institute 920 E 28th Street #300 Minneapolis, Minnesota 55407 Tel: 612-863-3900.
Background There is equipoise about the optimal initial strategy for crossing coronary chronic total occlusions.
Objectives We performed a multicenter, randomized-controlled, clinical trial comparing upfront use of the CrossBoss catheter vs. antegrade wire escalation for antegrade crossing of 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 utilization.
Results Between 2015 and 2017, 246 patients were randomized to CrossBoss (n=122) or wire escalation (n=124) at 11 US 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 two groups. Crossing time was similar: 56 (interquartile ranges: 33, 93) min in the CrossBoss and 66 (36, 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 utilization and cost.
- percutaneous coronary intervention
- chronic total occlusion
- antegrade dissection/re-entry
- antegrade wire escalation
Research was supported by a research grant from Boston Scientific.
Dr. Rangan: Research grants from InfraReDx, Inc., and The Spectranetics Corporation
Dr. Nicholson: Advisory Board, Speaker's Bureau, Proctoring: Abbott Vascular, Boston Scientific, Asahi Intecc, Medtronic.
Dr. Harvey: consultant for Boston Scientific
Dr. Spaedy: Consulting for Abbott Vascular, Medtronic and Boston Scientific.
Dr. Jaffer: Consultant: Abbott Vascular and Boston Scientific. Research Grant: Canon, Siemens, National Institutes of Health.
Dr. Lombardi: equity with Bridgepoint Medical
Dr. Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories.
Dr. Banerjee: research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel.
Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, Amgen, Asahi, CSI, Elsevier, GE Healthcare, and Medicure; research support from Boston Scientific and Osprey; spouse is employee of Medtronic.
All other authors: none
- Received October 9, 2017.
- Revision received October 15, 2017.
- Accepted October 19, 2017.