Laser wire for crossing chronic total occlusions: 'Learning phase' results from the U.S. TOTAL trial

Stephen N. Oesterle, John A. Bittl, Martin B. Leon, Jaap Hamburger, James E. Tcheng, Frank Litvack, James Margolis, Paul Gilmore, Ronald Madsen, David Holmes, Jeffrey Moses, Howard Cohen, Spencer King, Jeffrey Brinker, Terence Hale, Dean J. Geraci, William J. Kerker, Jeffrey Popma

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

The Prima laser guidewire system (Spectranectics Corp., Colorado Springs, CO) consists of an 0.018'' hypotube containing a bundle of 45-μm optical fibers coupled to a pulsed excimer laser operating at a tip fluence of 60 ml/mm2 and a repetition rate ranging from 25-40 Hz. This laser guidewire was specifically designed to cross total occlusions refractory to passage with conventional wires. The Prima wire was evaluated in a feasibility study at 15 U.S. centers. Following failure to cross s total occlusion with approved guidewires, the Prima wire was utilized in 179 patients. Average age of subjects was 61 yr. Lesion locations included left anterior descending (36%), right (45%), and circumflex (19%) coronary arteries. Mean angiographic age of total occlusions was 70 wk (range, 2- 1,020 wk, median, 14 wk). The use of the Prima wire either solely or in combination with conventional guidewires resulted in successful crossing in 61% of these previously impenetrable occlusions. Failure of the device was commonly related to length of the occlusion and tortuosity along the occluded pathway. Major complications included myocardial infarction in 7 patients (3.9%), tamponade in 3 (1.7%), and death in 2 (1.1%). This 'learning phase' pilot study confirmed the feasibility of a laser guidewire in chronic total occlusions that are resistant to passage of conventional guidewires. An extended registry at these investigative sites is planned.

Original languageEnglish (US)
Pages (from-to)235-243
Number of pages9
JournalCatheterization and cardiovascular diagnosis
Volume44
Issue number2
DOIs
StatePublished - Jun 1 1998

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Keywords

  • Angioplasty
  • Chronic total occlusion
  • Guidewire
  • Laser

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Oesterle, S. N., Bittl, J. A., Leon, M. B., Hamburger, J., Tcheng, J. E., Litvack, F., Margolis, J., Gilmore, P., Madsen, R., Holmes, D., Moses, J., Cohen, H., King, S., Brinker, J., Hale, T., Geraci, D. J., Kerker, W. J., & Popma, J. (1998). Laser wire for crossing chronic total occlusions: 'Learning phase' results from the U.S. TOTAL trial. Catheterization and cardiovascular diagnosis, 44(2), 235-243. https://doi.org/10.1002/(SICI)1097-0304(199806)44:2<235::AID-CCD23>3.0.CO;2-K