Dec 16, 2021 by Philips
Reading time: 1-2 minutes

Chronic total occlusions

Incidence increases with age, yet older patients are less likely to have PCI attempted.¹ Furthermore, 18% of PCIs have a CTO, but less than 5% are being treated.²

Clinical challenges

CTOs are difficult to wire and re-canalize, resulting in lengthy procedures and potentially higher radiation exposure and contrast use.
CTOs are often associated with lower procedural success rates, increased restenosis and re-occlusion compared with non-CTO procedures.
Hard proximal caps often prevent therapy from being delivered.

IVUS-guided vs. angiography-guided outcomes³

ELCA Success and safety rates

Study	Lesion type	Technical success	Procedural success	MACE Rates*
Bilodeau	Calcified and complex coronary lesions	92.0%	93.0%	8.0%
	Calcified, uncrossable, resistant coronary lesions	95.5%	95.5%	8.0%
Pratsos	Crossable coronary lesions	98.1%	99.0%	0.0%

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Advanced tools for optimal PCI outcomes

IVUS Co-registration

Optimizes vessel sizing for treatment strategy and to confirm final result.
Provides enhanced and stabilized angiographic views.
Study data reports when IVUS was used to help guide treatment there was a significantly lower TVF rate at 3 years vs angiography alone.⁴

Angio Sculpt Evo RX PTCA scoring balloon catheter

AngioSculpt RX PTCA

Provides the power necessary to maximize lume diameter.
Delivers 15-25x’s the focal force of a traditional balloon.⁵

ELCA coronary laser atherectomy catheter

The only coronary atherectomy device with a CTO indication.*
Enables crossing 94% of lesions which previously failed balloon angioplasty.⁶
Modifies plaque and creates a channel facilitating delivery of therapeutic devices.
Delivers over any wire already across a CTO, unlike other atherectomy devices.

*Total occlusions traversable by a guide wire.

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References

^1.Stone, G., et. al. (2005). Percutaneous recanalization of chronically occluded coronary arteries: A consensus document: Part 1. Circulation, 112, 2364-2372.

^2.National Cardiac Data Registry (2016).

³. Kim BK, Shin DH, Hong MK, et al. Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study. Circ Cardiovasc Interv 2015;8:e002592.

^4.Gao XF, Ge Z, Kong XQ, et al., Three-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation JACC: Cardiovascular Interventions (2020), doi: www.doi.org/10.1016/j.jcin.2020.10.001.

^5. AngioSculpt Test Report SR-1571 (2008)

^6. Ambrosini, V, et.al. Early outcomes of high energy laser (Excimer) facilitated coronary angioplasty on hard and complex calcified and balloon resistant coronary lesions: LEONARDO Study. Card. Revasc. Med 2015: 16: 141-146.