Tornus catheter and rotational atherectomy in resistant chronic total occlusions

Background: Although the inability to cross the chronic total occlusion (CTO) with a guidewire is the most common reason for failure, one of the most frustrating situations that may occur during a recanalization procedure is when a guidewire crosses successfully but it is impossible to advance any device over the wire through the occluded segment. We assessed the application of the Tornus catheter and/or rotational atherectomy to improve the success rate of percutaneous recanalization of CTO. Methods: From October 2009 to May 2011, 55 consecutive patients with CTO resistant to recanalization by conventional techniques were treated by the following step-by-step approach: 1) Tornus catheter and 2) eventual high speed rotational atherectomy. Results: Twenty-four lesions were successfully crossed by the Tornus catheter (43.5%). Rotational atherectomy was used in 31 patients (one with Tornus success and 30 with Tornus failure). A final angiographic success was obtained in 50/55 patients (91%) whereas in 5 patients both bail-out strategies failed (9%). As compared to the 24 CTO successfully treated by the Tornus catheter (Tornus-success group), the 31 patients in the Tornus-failure group were treated more often with the 2.1 F Tornus catheter and had more severely calcified lesions. By multivariable regression analysis the single independent predictor of Tornus failure was the presence of severely calcified lesions. Conclusions: The Tornus catheter is a safe and effective device allowing us to overcome the inability to cross a CTO with a balloon catheter in approximately 45% of cases. In severely calcified CTO rotational atherectomy should be performed first. (C) 2012 Elsevier Ireland Ltd. All rights reserved.