Zhongguo quanke yixue (Oct 2023)
Evaluation of the Efficacy and Safety of "Crowbar Effect" Technique to Facilitate Balloon Crossing Resistant Chronic Total Occlusions Lesions
Abstract
Background The inability of the balloon to cross coronary chronic total occlusion (CTO) lessions is one of the reasons for the failure of percutaneous coronary intervention (PCI) in the revascularization of CTO. Objective To evaluate the efficacy and safety of the "Crowbar Effect" technique to facilitate balloon crossing resistant CTO lesions, so as to provide an alternative novel technique for CTO recanalization and improving the success rate of CTO recanalization. Methods A total of 648 patients with coronary artery CTO lesions treated by antegrade approach at Beijing Anzhen Hospital, Capital Medical University and the Affiliated Hospital of Beihua University from January 2010 to January 2019 were collected, 84 (12.96%) cases of whom suffered from resistant CTO lesions which could be not crossed with balloon after the first guide wire successfully crossed the lesions. The "Crowbar Effect" technique was applied to those patients to facilitate the small-sized balloon crossing CTO lesions to complete PCI. The success rate of PCI and incidence of major adverse cardiac events (MACE) were observed. Results The average J-score of CTO lesions in 84 patients was (1.63±0.90). After successful crossing of the first guide wire through the CTO lesions, the success rate of small-sized balloon crossing CTO lesions was 91.67% (77/84) due to the use of "Crowbar Effect" technique. There were still failures in 7 cases (8.33%), including 2 cases caused by 360-degree severe calcified lesions and 5 cases caused by coronary artery perforation. No perioperative cardiac death or nonfatal myocardial infarction occurred in 84 patients. Conclusion The "Crowbar Effect" technique is effective and safe in facilitating small-sized balloons to cross balloon uncrossable CTO lesions. The application of this simple technique has a high success rate and application value for CTO recanalization.
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