CHRONIC TOTAL OCCLUSION AN EMERGING AND CHALLENGING TREATMENT While chronic total occlusion (CTO) treatment has been present within the cardiovascular field for several years, there is an increased emphasis on new approaches and technology dedicated to this area.
A lesion is considered a CTO if it:
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Is 99%–100% occluded Has a TIMI flow of 0
Has been occluded over three months
There are three main approaches to CTO treatment:
1. Antegrade wire escalation 2. Antegrade dissection/reentry 3. Retrograde collateral bypass
It is estimated that 20%–25% of all patients with coronary artery disease (CAD) have a CTO. There are an estimated one million percutaneous cardiac interventions (PCI) performed in the United States each year. Of these, approximately 5%, or 50,000, are performed as a CTO case. However, it is also estimated that over 100,000 patients are potentially untreated CTO cases. One estimate indicates that only 5% of the interventional cardiologists in the U.S. have the recommended specialized training to tackle these lesions. The experience of the physician, the experience of the procedural staff, and the availability of a wide range of equipment and supplies dedicated to the treatment of CTO all influence success rates. These tools include guide catheters, ultra-low-profile balloons, specialized crossing wires, and microcatheters. Microcatheters provide an increased ability to cross a lesion and assist in the exchange of guidewires and the delivery of contrast material. Microcatheters work in tandem with CTO wires and provide specific benefits:
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Penetrability Torque control Physician “feel”
Pushabilty
TZ Medical is now able to provide a new microcatheter, which can be an important addition to the “toolbox” for CTO cases. The M-Cath is a microcatheter intended for use in an antegrade approach and provides these important features:
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An ergonomic hub
A hypotube shaft with a reinforcing braided mesh A hydrophilic polymer coating for excellent lubricity
High torquability
A tapered and robust tip with a 1.6 Fr entry profile
135 cm usable length
Pushability is often considered one of the most important aspects of any microcatheter. The M-cath delivers this critical element and the other specialty features to enhance the potential of successfully crossing the most challenging of CTO cases.
–Dan Scharbach
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