Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: The CrossBoss First Trial

Judit Karacsonyi, Peter Tajti, Bavana V. Rangan, Sean C. Halligan, Raymond H. Allen, William J. Nicholson, James E. Harvey, Anthony J. Spaedy, Farouc A. Jaffer, J. Aaron Grantham, Adam Salisbury, Anthony J. Hart, David M. Safley, William L. Lombardi, Ravi Hira, Creighton Don, James M. McCabe, M. Nicholas Burke, Khaldoon Alaswad, Gerald C. KoenigKintur A. Sanghvi, Daniel Ice, Richard C. Kovach, Vincent Varghese, Bilal Murad, Kenneth W. Baran, Erica Resendes, Jose R. Martinez-Parachini, Aris Karatasakis, Barbara A. Danek, Rahel Iwnetu, Michele Roesle, Houman Khalili, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)287-297
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume11
Issue number3
DOIs
StatePublished - Feb 12 2018

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Keywords

  • antegrade dissection/re-entry
  • antegrade wire escalation
  • chronic total occlusion
  • CrossBoss
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Karacsonyi, J., Tajti, P., Rangan, B. V., Halligan, S. C., Allen, R. H., Nicholson, W. J., Harvey, J. E., Spaedy, A. J., Jaffer, F. A., Grantham, J. A., Salisbury, A., Hart, A. J., Safley, D. M., Lombardi, W. L., Hira, R., Don, C., McCabe, J. M., Burke, M. N., Alaswad, K., ... Brilakis, E. S. (2018). Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: The CrossBoss First Trial. JACC: Cardiovascular Interventions, 11(3), 287-297. https://doi.org/10.1016/j.jcin.2017.10.023