Chronic Total Occlusion (CTO) Devices Are Key - VascularWeb

Chronic Total Occlusion (CTO)Devices Are Key -What’s Out There and NewNeal S Cayne, MDDirector of Endovascular SurgeryDivision of Vascular SurgeryNew York University Langone Medical CenterNew York, NYDivision of Vascular and Endovascular Surgery

NO DISCLOSURES2Division of Vascular and Endovascular Surgery

Crossing Devices•3Division of Vascular and Endovascular Surgery

Crossing Devices• Avenger - Wild Cat• Bard - Crosser• Baylis - Powerwire• BSC - Truepath• Cordis - Frontrunner• Coviden - Viance4Division of Vascular and Endovascular Surgery

Re-entry Devices• BSC - Offroad• Cordis - Outback• Coviden - Enteer• Medtronic - Pioneer5Division of Vascular and Endovascular Surgery

Avenger - Wildcat• Rotatable Tip• Passive and Active• 6 Fr, 0.035”• Hydrophilic coating• Manual or Powered6Division of Vascular and Endovascular Surgery

Avenger - Wildcat7Division of Vascular and Endovascular Surgery

Avenger - Wildcat•8Division of Vascular and Endovascular Surgery

Avenger - Wildcat• CONNECT Trial- Technical Success – 89.3%- Average CTO length – 17.4 CM9Division of Vascular and Endovascular Surgery

Avenger - Kittycat• Kittycat, Kittycat 2• .014” versions• Tight lesions/tibial lesions10Division of Vascular and Endovascular Surgery

Avenger - OCELOT• Optical Coherence Tomography(OCT)• Real time intravascular cross sectionalimaging• CONNECT II - 97% Crossing successDivision of Vascular and Endovascular Surgery11

Bard - Crosser• High Frequency Mechanical Vibration• Reusable Electronic Generator• 3.9-4.8 Fr (5 Fr sheath)• .014” or .018”• Stainless Steel Tip• Hard or calcified lesionsDivision of Vascular and Endovascular Surgery12

Bard - Crosser• Support Catheter (Microsheath)• Angled• Requires 7 Fr sheath13Division of Vascular and Endovascular Surgery

Bard - Crosser14Division of Vascular and Endovascular Surgery

Bard - Crosser15Division of Vascular and Endovascular Surgery

Bard - Crosser16Division of Vascular and Endovascular Surgery

Bard - Crosser17Division of Vascular and Endovascular Surgery

Bard - Crosser18Division of Vascular and Endovascular Surgery

Bard - Crosser• PATRIOT Trial- Technical Success – 84%- Average CTO – 11.8 CM19Division of Vascular and Endovascular Surgery

Baylis - PowerWire• Radiofrequency Energy• Generator – Optimized for Venous• Await Arterial Generator in US• OD - .035”• Wire can be used for intervention20Division of Vascular and Endovascular Surgery

Baylis PowerWire21Division of Vascular and Endovascular Surgery

Boston Scientific - TruePath• Rotating Diamond Tip• On table power source• .018” Wire22Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath23Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath24Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath25Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath26Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath27Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath28Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath29Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath30Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath31Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath32Division of Vascular and Endovascular Surgery

Boson Scientific - TruePath• ReOpen Trial- 80% Success33Division of Vascular and Endovascular Surgery

Cordis - Frontrunner• Blunt Microdissection• Mechanical Jaws• Manually Operated• .039”34Division of Vascular and Endovascular Surgery

Cordis - Frontrunner• Micro Guide support catheter• Conduit for rapid wire exchange35Division of Vascular and Endovascular Surgery

Cordis - Frontrunner•36Division of Vascular and Endovascular Surgery

Cordis - Frontrunner•37Division of Vascular and Endovascular Surgery

Cordis - Frontrunner•38Division of Vascular and Endovascular Surgery

Coviden - Viance• Intraluminal or subintimal• .014”, blunt• Spun – torque device• Rapid Manual Turning• No capital equipment39Division of Vascular and Endovascular Surgery

Coviden - Viance40Division of Vascular and Endovascular Surgery

Coviden - Viance41Division of Vascular and Endovascular Surgery

Coviden - Viance42Division of Vascular and Endovascular Surgery

Coviden - Viance43Division of Vascular and Endovascular Surgery

Coviden - Viance44Division of Vascular and Endovascular Surgery

Coviden - Viance45Division of Vascular and Endovascular Surgery

Coviden - Viance• PFAST-CTOs• 84% Technical success46Division of Vascular and Endovascular Surgery

Re-entry Devices• BSC - Offroad• Cordis - Outback• Coviden - Enteer• Medtronic - Pioneer47Division of Vascular and Endovascular Surgery

Boston Scientific - Offroad• Conical balloon 5.4mm• When inflated, points toward truelumen• Microcatheter lancet• Clinical Trials48Division of Vascular and Endovascular Surgery

Boston Scientific - Offroad49Division of Vascular and Endovascular Surgery

Cordis - Outback• 6 Fr Catheter• .014” wire• Premounted needle• Fluoroscopic orientation-“T” or “L”• Poke into true lumen50Division of Vascular and Endovascular Surgery

Cordis Outback• Orient “L”shapedmarkertowardslumen51Division of Vascular and Endovascular Surgery

Cordis Outback• Orient “L”shapedmarkertowardslumen52Division of Vascular and Endovascular Surgery

Cordis Outback• Orient “L”shapedmarkertowardslumen53Division of Vascular and Endovascular Surgery

Coviden - Enteer• Flat balloon orients itself in subintimalspace - .018”• Points needle toward true lumen• Balloon (2.75/3.75mm)• Below and above kneeDivision of Vascular and Endovascular Surgery54

Coviden - Enteer55Division of Vascular and Endovascular Surgery

Coviden - Enteer56Division of Vascular and Endovascular Surgery

Coviden - Enteer57Division of Vascular and Endovascular Surgery

Coviden - Enteer58Division of Vascular and Endovascular Surgery

Coviden - Enteer59Division of Vascular and Endovascular Surgery

Medtronic - Pioneer• Similar to Outback• 6F• Premounted needle• IVUS guided• Volcano60Division of Vascular and Endovascular Surgery

Conclusion• CTO/re-entry devices add to ourarmamentarium for the treatmentof CTOs.• Devices can increase the likelihoodof success when standardwires/catheters fail.• Future - Cost of these devices maybe a limiting factor.61Division of Vascular and Endovascular Surgery

Division of Vascular and Endovascular Surgery