Staniloae Cezar S, Mody Kanika P, Yadav Sidharth S, Han Seol Young, Korabathina Ravikiran
NYU Langone Medical Center, Cardiac and Vascular Institute, 550 First Avenue, New York, NY 10016 USA.
J Invasive Cardiol. 2011 Sep;23(9):359-62.
Revascularization of lower extremity chronic total occlusions (CTOs) is technically challenging. The Crosser® recanalization catheter was designed to facilitate distal vessel intraluminal entry that is both rapid and safe. We present our experience with the Crosser device as primary therapy for peripheral CTOs.
Subjects undergoing evaluation for arterial insufficiency at our institution between 2008-2010 who were noted to have a CTO in the lower extremity by duplex ultrasonography and who subsequently underwent Crosser recanalization were enrolled. Clinical characteristics, ankle-brachial indices, Rutherford-Becker symptom category, and angiographic CTO parameters were collected. Primary technical success was intraluminal delivery of the guidewire into the distal vessel solely by the Crosser device. Secondary technical success was assisted delivery using the Outback LTD® re-entry device. Safety endpoints were the occurrence of dissections, thromboembolism, and perforations related to the Crosser device. Statistical analysis was performed to find independent predictors for failure to achieve Crosser recanalization.
Fifty-six subjects with 73 CTOs were enrolled. The mean Crosser use time was 17.6 ± 12.7 minutes. The overall primary and secondary technical success rates for Crosser recanalization were 76.7% and 87.7%, respectively. Technical success was highest for CTOs located in the aorto-iliac (90.0%) and tibial (95.2%) arterial segments. There were no perforations related to the Crosser device. For successful cases, the mean ABI improved significantly from pre- to post-intervention (0.57 ± 0.13 to 0.89 ± 0.15, p < 0.001). The only predictors for failure were lesion length longer than 100 mm (p = 0.04) and calcification within 10 mm of the exit cap (p = 0.02).
The Crosser device is safe and shows excellent efficacy in facilitating guidewire distal lumen entry, especially for aorto-iliac and tibial occlusions. The technical success rate for the femoral and popliteal occlusions is comparable to those reported with other recanalization techniques.
下肢慢性完全闭塞病变（CTO）的血管重建术在技术上具有挑战性。Crosser®再通导管旨在实现快速且安全的远端血管腔内进入。我们介绍了将Crosser装置作为外周CTO主要治疗方法的经验。
纳入2008年至2010年间在我们机构接受动脉供血不足评估的受试者，这些受试者经双功超声检查发现下肢存在CTO，随后接受了Crosser再通治疗。收集临床特征、踝肱指数、卢瑟福-贝克尔症状分类和血管造影CTO参数。主要技术成功定义为仅通过Crosser装置将导丝腔内输送至远端血管。次要技术成功定义为使用Outback LTD®再入路装置辅助输送。安全终点是与Crosser装置相关的夹层、血栓栓塞和穿孔的发生情况。进行统计分析以找出未能实现Crosser再通的独立预测因素。
纳入了56例患有73处CTO的受试者。Crosser装置的平均使用时间为17.6±12.7分钟。Crosser再通的总体主要和次要技术成功率分别为76.7%和87.7%。位于主-髂动脉（90.0%）和胫动脉（95.2%）段的CTO技术成功率最高。没有与Crosser装置相关的穿孔。对于成功的病例，干预前后平均踝肱指数显著改善（从0.57±0.13至0.89±0.15，p<0.001）。失败的唯一预测因素是病变长度超过100mm（p = 0.04）和出口帽10mm范围内的钙化（p = 0.02）。
Crosser装置安全，在促进导丝进入远端管腔方面显示出优异的疗效，特别是对于主-髂动脉和胫动脉闭塞。股动脉和腘动脉闭塞的技术成功率与其他再通技术报道的相当。
