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. Koenig & 15 others Kintur 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

12 Citations (Scopus)

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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Catheters
Fluoroscopy
Equipment and Supplies
Randomized Controlled Trials
Air
Radiation
Costs and Cost Analysis
Incidence
boldenone undecylenate

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

Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions : The CrossBoss First Trial. / Karacsonyi, Judit; Tajti, Peter; Rangan, Bavana V.; Halligan, Sean C.; Allen, Raymond H.; Nicholson, William J.; Harvey, James E.; Spaedy, Anthony J.; Jaffer, Farouc A.; Grantham, J. Aaron; Salisbury, Adam; Hart, Anthony J.; Safley, David M.; Lombardi, William L.; Hira, Ravi; Don, Creighton; McCabe, James M.; Burke, M. Nicholas; Alaswad, Khaldoon; Koenig, Gerald C.; Sanghvi, Kintur A.; Ice, Daniel; Kovach, Richard C.; Varghese, Vincent; Murad, Bilal; Baran, Kenneth W.; Resendes, Erica; Martinez-Parachini, Jose R.; Karatasakis, Aris; Danek, Barbara A.; Iwnetu, Rahel; Roesle, Michele; Khalili, Houman; Banerjee, Subhash; Brilakis, Emmanouil S.

In: JACC: Cardiovascular Interventions, Vol. 11, No. 3, 12.02.2018, p. 287-297.

Research output: Contribution to journalArticle

Karacsonyi, J, Tajti, P, Rangan, BV, Halligan, SC, Allen, RH, Nicholson, WJ, Harvey, JE, Spaedy, AJ, Jaffer, FA, Grantham, JA, Salisbury, A, Hart, AJ, Safley, DM, Lombardi, WL, Hira, R, Don, C, McCabe, JM, Burke, MN, Alaswad, K, Koenig, GC, Sanghvi, KA, Ice, D, Kovach, RC, Varghese, V, Murad, B, Baran, KW, Resendes, E, Martinez-Parachini, JR, Karatasakis, A, Danek, BA, Iwnetu, R, Roesle, M, Khalili, H, Banerjee, S & Brilakis, ES 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, vol. 11, no. 3, pp. 287-297. https://doi.org/10.1016/j.jcin.2017.10.023
Karacsonyi, Judit ; Tajti, Peter ; Rangan, Bavana V. ; Halligan, Sean C. ; Allen, Raymond H. ; Nicholson, William J. ; Harvey, James E. ; Spaedy, Anthony J. ; Jaffer, Farouc A. ; Grantham, J. Aaron ; Salisbury, Adam ; Hart, Anthony J. ; Safley, David M. ; Lombardi, William L. ; Hira, Ravi ; Don, Creighton ; McCabe, James M. ; Burke, M. Nicholas ; Alaswad, Khaldoon ; Koenig, Gerald C. ; Sanghvi, Kintur A. ; Ice, Daniel ; Kovach, Richard C. ; Varghese, Vincent ; Murad, Bilal ; Baran, Kenneth W. ; Resendes, Erica ; Martinez-Parachini, Jose R. ; Karatasakis, Aris ; Danek, Barbara A. ; Iwnetu, Rahel ; Roesle, Michele ; Khalili, Houman ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions : The CrossBoss First Trial. In: JACC: Cardiovascular Interventions. 2018 ; Vol. 11, No. 3. pp. 287-297.
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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.",
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author = "Judit Karacsonyi and Peter Tajti and Rangan, {Bavana V.} and Halligan, {Sean C.} and Allen, {Raymond H.} and Nicholson, {William J.} and Harvey, {James E.} and Spaedy, {Anthony J.} and Jaffer, {Farouc A.} and Grantham, {J. Aaron} and Adam Salisbury and Hart, {Anthony J.} and Safley, {David M.} and Lombardi, {William L.} and Ravi Hira and Creighton Don and McCabe, {James M.} and Burke, {M. Nicholas} and Khaldoon Alaswad and Koenig, {Gerald C.} and Sanghvi, {Kintur A.} and Daniel Ice and Kovach, {Richard C.} and Vincent Varghese and Bilal Murad and Baran, {Kenneth W.} and Erica Resendes and Martinez-Parachini, {Jose R.} and Aris Karatasakis and Danek, {Barbara A.} and Rahel Iwnetu and Michele Roesle and Houman Khalili and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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T1 - Randomized Comparison of a CrossBoss First Versus Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions

T2 - The CrossBoss First Trial

AU - Karacsonyi, Judit

AU - Tajti, Peter

AU - Rangan, Bavana V.

AU - Halligan, Sean C.

AU - Allen, Raymond H.

AU - Nicholson, William J.

AU - Harvey, James E.

AU - Spaedy, Anthony J.

AU - Jaffer, Farouc A.

AU - Grantham, J. Aaron

AU - Salisbury, Adam

AU - Hart, Anthony J.

AU - Safley, David M.

AU - Lombardi, William L.

AU - Hira, Ravi

AU - Don, Creighton

AU - McCabe, James M.

AU - Burke, M. Nicholas

AU - Alaswad, Khaldoon

AU - Koenig, Gerald C.

AU - Sanghvi, Kintur A.

AU - Ice, Daniel

AU - Kovach, Richard C.

AU - Varghese, Vincent

AU - Murad, Bilal

AU - Baran, Kenneth W.

AU - Resendes, Erica

AU - Martinez-Parachini, Jose R.

AU - Karatasakis, Aris

AU - Danek, Barbara A.

AU - Iwnetu, Rahel

AU - Roesle, Michele

AU - Khalili, Houman

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2018/2/12

Y1 - 2018/2/12

N2 - 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.

AB - 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.

KW - antegrade dissection/re-entry

KW - antegrade wire escalation

KW - chronic total occlusion

KW - CrossBoss

KW - percutaneous coronary intervention

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DO - 10.1016/j.jcin.2017.10.023

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JO - JACC: Cardiovascular Interventions

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