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 Citations (Scopus)

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

Fingerprint

Lasers
Learning
Equipment Failure
Optical Fibers
Excimer Lasers
Feasibility Studies
Carbon Monoxide
Registries
Coronary Vessels
Myocardial Infarction

Keywords

  • Angioplasty
  • Chronic total occlusion
  • Guidewire
  • Laser

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Laser wire for crossing chronic total occlusions : 'Learning phase' results from the U.S. TOTAL trial. / Oesterle, Stephen N.; Bittl, John A.; Leon, Martin B.; Hamburger, Jaap; Tcheng, James E.; Litvack, Frank; Margolis, James; Gilmore, Paul; Madsen, Ronald; Holmes, David; Moses, Jeffrey; Cohen, Howard; King, Spencer; Brinker, Jeffrey; Hale, Terence; Geraci, Dean J.; Kerker, William J.; Popma, Jeffrey.

In: Catheterization and cardiovascular diagnosis, Vol. 44, No. 2, 01.06.1998, p. 235-243.

Research output: Contribution to journalArticle

Oesterle, SN, Bittl, JA, Leon, MB, Hamburger, J, Tcheng, JE, Litvack, F, Margolis, J, Gilmore, P, Madsen, R, Holmes, D, Moses, J, Cohen, H, King, S, Brinker, J, Hale, T, Geraci, DJ, Kerker, WJ & Popma, J 1998, 'Laser wire for crossing chronic total occlusions: 'Learning phase' results from the U.S. TOTAL trial', Catheterization and cardiovascular diagnosis, vol. 44, no. 2, pp. 235-243. https://doi.org/10.1002/(SICI)1097-0304(199806)44:2<235::AID-CCD23>3.0.CO;2-K
Oesterle, Stephen N. ; Bittl, John A. ; Leon, Martin B. ; Hamburger, Jaap ; Tcheng, James E. ; Litvack, Frank ; Margolis, James ; Gilmore, Paul ; Madsen, Ronald ; Holmes, David ; Moses, Jeffrey ; Cohen, Howard ; King, Spencer ; Brinker, Jeffrey ; Hale, Terence ; Geraci, Dean J. ; Kerker, William J. ; Popma, Jeffrey. / Laser wire for crossing chronic total occlusions : 'Learning phase' results from the U.S. TOTAL trial. In: Catheterization and cardiovascular diagnosis. 1998 ; Vol. 44, No. 2. pp. 235-243.
@article{65875237c22e481b8b9cb77aeacf4311,
title = "Laser wire for crossing chronic total occlusions: 'Learning phase' results from the U.S. TOTAL trial",
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.",
keywords = "Angioplasty, Chronic total occlusion, Guidewire, Laser",
author = "Oesterle, {Stephen N.} and Bittl, {John A.} and Leon, {Martin B.} and Jaap Hamburger and Tcheng, {James E.} and Frank Litvack and James Margolis and Paul Gilmore and Ronald Madsen and David Holmes and Jeffrey Moses and Howard Cohen and Spencer King and Jeffrey Brinker and Terence Hale and Geraci, {Dean J.} and Kerker, {William J.} and Jeffrey Popma",
year = "1998",
month = "6",
day = "1",
doi = "10.1002/(SICI)1097-0304(199806)44:2<235::AID-CCD23>3.0.CO;2-K",
language = "English (US)",
volume = "44",
pages = "235--243",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "2",

}

TY - JOUR

T1 - Laser wire for crossing chronic total occlusions

T2 - 'Learning phase' results from the U.S. TOTAL trial

AU - Oesterle, Stephen N.

AU - Bittl, John A.

AU - Leon, Martin B.

AU - Hamburger, Jaap

AU - Tcheng, James E.

AU - Litvack, Frank

AU - Margolis, James

AU - Gilmore, Paul

AU - Madsen, Ronald

AU - Holmes, David

AU - Moses, Jeffrey

AU - Cohen, Howard

AU - King, Spencer

AU - Brinker, Jeffrey

AU - Hale, Terence

AU - Geraci, Dean J.

AU - Kerker, William J.

AU - Popma, Jeffrey

PY - 1998/6/1

Y1 - 1998/6/1

N2 - 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.

AB - 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.

KW - Angioplasty

KW - Chronic total occlusion

KW - Guidewire

KW - Laser

UR - http://www.scopus.com/inward/record.url?scp=0031804263&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031804263&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1097-0304(199806)44:2<235::AID-CCD23>3.0.CO;2-K

DO - 10.1002/(SICI)1097-0304(199806)44:2<235::AID-CCD23>3.0.CO;2-K

M3 - Article

C2 - 9637452

AN - SCOPUS:0031804263

VL - 44

SP - 235

EP - 243

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 2

ER -