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Comparison of magnetic wire navigation with the conventional wire technique for percutaneous coronary intervention of chronic total occlusions: a randomised, controlled study

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Abstract

Wire crossing of a chronic total coronary occlusion (CTO) is time consuming and limited by the amount of contrast agent and time of radiation exposure. Magnetic wire navigation (MWN) might accelerate wire crossing by maintaining a coaxial vessel orientation. This study compares MWN with the conventional approach for recanalization of CTOs. Forty symptomatic patients with CTO were randomised to MWN (n = 20) or conventional approach (n = 20) for antegrade crossing of the occlusion. In the intention-to-treat analysis, MWN showed a shorter crossing time (412 versus 1131 s; p = 0.001), and, consequently, lower usage of contrast agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation exposure (dose-area product: 29 versus 80 Gy*cm2; p = 0.002) during wire crossing compared to the conventional approach. Accordingly, in the per-protocol analysis, the wire-crossing rate was, in trend, higher using the conventional approach (17 of 31) compared to MWN (9 of 28; p = 0.08). The use of MWN for revascularisation of CTOs is feasible and reduces crossing time, use of contrast agent, and radiation exposure. However, due to a broader selection of wires, the conventional approach enables wire crossing in cases failed by MWN and seems to be the more successful choice.

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    Authors and Affiliations

    1. Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria

      Christian Roth, Rudolf Berger, Sabine Scherzer, Lisa Krenn, Clemens Gangl, Daniel Dalos, Georg Delle-Karth & Thomas Neunteufl

    2. Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Eisenstadt, Austria

      Rudolf Berger

    3. Department of Internal Medicine IV, Cardiology, Hospital of Hietzing, Vienna, Austria

      Georg Delle-Karth

    4. Department of Internal Medicine I, Cardiology, University Hospital of Krems, Krems an der Donau, Austria

      Thomas Neunteufl

    5. Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria

      Thomas Neunteufl

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    1. Christian Roth
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    Correspondence to Rudolf Berger.

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    Conflict of interest

    Stereotaxis Inc. (St. Louis, MO, USA) provided financial support (unrestricted grant) for employment of a study coordinator. Dr. Berger reports receiving consulting fees from St. Jude Medical, Amacord, Abbott Vascular, and grant support from Pfizer. Dr. Delle-Karth serves on the scientific advisory boards of Abbott Vascular, Boston Scientific, and receives consulting fees from St. Jude Medical. Dr. Neunteufl serves on the scientific advisory boards of AstraZeneca, Biotronic, Bayer, BMS/Sanovi Aventis, Eli Lilly, receives consulting fees from Abbott Vascular, Boston Scientific, Edwards, St. Jude Medical, and grant support from AstraZeneca, Atrium Medical Corporation, Biosensors International, Boston Scientific, Eli Lilly, Medtronic, PRA, Schering-Plough. The remaining authors report no conflicts.

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    C. Roth and R. Berger contributed equally to this work.

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    Roth, C., Berger, R., Scherzer, S. et al. Comparison of magnetic wire navigation with the conventional wire technique for percutaneous coronary intervention of chronic total occlusions: a randomised, controlled study. Heart Vessels 31, 1266–1276 (2016). https://doi.org/10.1007/s00380-015-0739-0

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    • DOI: https://doi.org/10.1007/s00380-015-0739-0

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