Blunt microdissection for endovascular treatment of infrainguinal chronic total occlusions

Subhash Banerjee, Omar Hadidi, Atif Mohammad, Ali Alsamarah, Rahul Thomas, Karan Sarode, Puja Garg, Mirza S. Baig, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: To present a systematic safety evaluation of the CrossBoss blunt microdissection catheter for crossing peripheral chronic total occlusions (CTOs). Methods: Between July 2010 and July 2011, 15 patients (all men; mean age 60.7±9.1 years) underwent endovascular treatment of 17 infrainguinal CTOs that were resistant to guidewire passage, so the blunt microdissection catheter was employed to recanalize the artery. Fourteen lesions were de novo and 3 were in-stent restenoses. Sixteen lesions were in the superficial femoral artery; 8 of 17 CTOs were TASC II type D. Extensive calcification was present in 12 lesions. Mean lesion length was 182.9±66.2 mm (range 57-296). Results: Procedural success was 100% and successful crossing without the use of a re-entry device (technical success) was achieved in 15 cases. Twelve lesions were stented. Average fluoroscopy time was 36.5621.2 minutes (143.8±76.9 Gy*cm2 radiaton dose area product), during which a mean 172.16±2.2 mL of iodinated contrast were used. Two patients had access site hematomas that were treated conservatively, and there was no perforation, distal embolization, amputation, or need for urgent revascularization. During the mean follow-up of 11.4±0.1 months, 1 patient died, and none required an amputation or surgical revascularization. There was a significant improvement in ankle-brachial index (0.6±0.1 to 0.8±0.2, p=0.001) and symptoms as assessed by Rutherford class at 1 year. Four of 17 limbs required secondary revascularization procedures within 1 year. Conclusion: The CrossBoss blunt microdissection catheter facilitated successful crossing of CTOs in patients with infrainguinal lesions following unsuccessful guidewire crossing, with an acceptably low rate of periprocedural complications and significant improvement in symptoms.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalJournal of Endovascular Therapy
Volume21
Issue number1
DOIs
StatePublished - Feb 2014

Fingerprint

Microdissection
Catheters
Amputation
Ankle Brachial Index
Fluoroscopy
Femoral Artery
Therapeutics
Hematoma
Stents
Extremities
Arteries
Safety
Equipment and Supplies

Keywords

  • Blunt microdissection
  • Chronic total occlusion
  • Endovascular intervention
  • Lesion crossing devices
  • Lower limb
  • Peripheral artery disease
  • Peroneal artery
  • Popliteal artery
  • Recanalizaton devices
  • Superficial femoral artery
  • Tibial artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Blunt microdissection for endovascular treatment of infrainguinal chronic total occlusions. / Banerjee, Subhash; Hadidi, Omar; Mohammad, Atif; Alsamarah, Ali; Thomas, Rahul; Sarode, Karan; Garg, Puja; Baig, Mirza S.; Brilakis, Emmanouil S.

In: Journal of Endovascular Therapy, Vol. 21, No. 1, 02.2014, p. 71-78.

Research output: Contribution to journalArticle

Banerjee, Subhash ; Hadidi, Omar ; Mohammad, Atif ; Alsamarah, Ali ; Thomas, Rahul ; Sarode, Karan ; Garg, Puja ; Baig, Mirza S. ; Brilakis, Emmanouil S. / Blunt microdissection for endovascular treatment of infrainguinal chronic total occlusions. In: Journal of Endovascular Therapy. 2014 ; Vol. 21, No. 1. pp. 71-78.
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abstract = "Purpose: To present a systematic safety evaluation of the CrossBoss blunt microdissection catheter for crossing peripheral chronic total occlusions (CTOs). Methods: Between July 2010 and July 2011, 15 patients (all men; mean age 60.7±9.1 years) underwent endovascular treatment of 17 infrainguinal CTOs that were resistant to guidewire passage, so the blunt microdissection catheter was employed to recanalize the artery. Fourteen lesions were de novo and 3 were in-stent restenoses. Sixteen lesions were in the superficial femoral artery; 8 of 17 CTOs were TASC II type D. Extensive calcification was present in 12 lesions. Mean lesion length was 182.9±66.2 mm (range 57-296). Results: Procedural success was 100{\%} and successful crossing without the use of a re-entry device (technical success) was achieved in 15 cases. Twelve lesions were stented. Average fluoroscopy time was 36.5621.2 minutes (143.8±76.9 Gy*cm2 radiaton dose area product), during which a mean 172.16±2.2 mL of iodinated contrast were used. Two patients had access site hematomas that were treated conservatively, and there was no perforation, distal embolization, amputation, or need for urgent revascularization. During the mean follow-up of 11.4±0.1 months, 1 patient died, and none required an amputation or surgical revascularization. There was a significant improvement in ankle-brachial index (0.6±0.1 to 0.8±0.2, p=0.001) and symptoms as assessed by Rutherford class at 1 year. Four of 17 limbs required secondary revascularization procedures within 1 year. Conclusion: The CrossBoss blunt microdissection catheter facilitated successful crossing of CTOs in patients with infrainguinal lesions following unsuccessful guidewire crossing, with an acceptably low rate of periprocedural complications and significant improvement in symptoms.",
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AU - Hadidi, Omar

AU - Mohammad, Atif

AU - Alsamarah, Ali

AU - Thomas, Rahul

AU - Sarode, Karan

AU - Garg, Puja

AU - Baig, Mirza S.

AU - Brilakis, Emmanouil S.

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N2 - Purpose: To present a systematic safety evaluation of the CrossBoss blunt microdissection catheter for crossing peripheral chronic total occlusions (CTOs). Methods: Between July 2010 and July 2011, 15 patients (all men; mean age 60.7±9.1 years) underwent endovascular treatment of 17 infrainguinal CTOs that were resistant to guidewire passage, so the blunt microdissection catheter was employed to recanalize the artery. Fourteen lesions were de novo and 3 were in-stent restenoses. Sixteen lesions were in the superficial femoral artery; 8 of 17 CTOs were TASC II type D. Extensive calcification was present in 12 lesions. Mean lesion length was 182.9±66.2 mm (range 57-296). Results: Procedural success was 100% and successful crossing without the use of a re-entry device (technical success) was achieved in 15 cases. Twelve lesions were stented. Average fluoroscopy time was 36.5621.2 minutes (143.8±76.9 Gy*cm2 radiaton dose area product), during which a mean 172.16±2.2 mL of iodinated contrast were used. Two patients had access site hematomas that were treated conservatively, and there was no perforation, distal embolization, amputation, or need for urgent revascularization. During the mean follow-up of 11.4±0.1 months, 1 patient died, and none required an amputation or surgical revascularization. There was a significant improvement in ankle-brachial index (0.6±0.1 to 0.8±0.2, p=0.001) and symptoms as assessed by Rutherford class at 1 year. Four of 17 limbs required secondary revascularization procedures within 1 year. Conclusion: The CrossBoss blunt microdissection catheter facilitated successful crossing of CTOs in patients with infrainguinal lesions following unsuccessful guidewire crossing, with an acceptably low rate of periprocedural complications and significant improvement in symptoms.

AB - Purpose: To present a systematic safety evaluation of the CrossBoss blunt microdissection catheter for crossing peripheral chronic total occlusions (CTOs). Methods: Between July 2010 and July 2011, 15 patients (all men; mean age 60.7±9.1 years) underwent endovascular treatment of 17 infrainguinal CTOs that were resistant to guidewire passage, so the blunt microdissection catheter was employed to recanalize the artery. Fourteen lesions were de novo and 3 were in-stent restenoses. Sixteen lesions were in the superficial femoral artery; 8 of 17 CTOs were TASC II type D. Extensive calcification was present in 12 lesions. Mean lesion length was 182.9±66.2 mm (range 57-296). Results: Procedural success was 100% and successful crossing without the use of a re-entry device (technical success) was achieved in 15 cases. Twelve lesions were stented. Average fluoroscopy time was 36.5621.2 minutes (143.8±76.9 Gy*cm2 radiaton dose area product), during which a mean 172.16±2.2 mL of iodinated contrast were used. Two patients had access site hematomas that were treated conservatively, and there was no perforation, distal embolization, amputation, or need for urgent revascularization. During the mean follow-up of 11.4±0.1 months, 1 patient died, and none required an amputation or surgical revascularization. There was a significant improvement in ankle-brachial index (0.6±0.1 to 0.8±0.2, p=0.001) and symptoms as assessed by Rutherford class at 1 year. Four of 17 limbs required secondary revascularization procedures within 1 year. Conclusion: The CrossBoss blunt microdissection catheter facilitated successful crossing of CTOs in patients with infrainguinal lesions following unsuccessful guidewire crossing, with an acceptably low rate of periprocedural complications and significant improvement in symptoms.

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KW - Recanalizaton devices

KW - Superficial femoral artery

KW - Tibial artery

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