dec 16, 2021 by Philips
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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

Chronic total occlusions

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

CTO Angio vs IVUS graphic

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 software image

  • 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

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

ELCA product

  • 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.

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.

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