Boston Scientific's CrossBoss Catheter Compared to Wire Escalation for Crossing CTOs
February 5, 2018—Findings from the CrossBoss First trial were published by Judit Karacsonyi, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2018;11:225–233).
The multicenter, randomized controlled clinical trial compared upfront use of the CrossBoss catheter (Boston Scientific Corporation) versus antegrade wire escalation for antegrade crossing of coronary chronic total occlusions (CTOs). In October 2017, the findings were presented at TCT 2017, the 29th annual Transcatheter Cardiovascular Therapeutics scientific symposium.
As summarized in JACC: Cardiovascular Interventions, the study's primary endpoints were the time required to cross the CTO or abort the procedure and the frequency of procedural major adverse cardiovascular events. The secondary endpoints were technical and procedural success, total procedure time, fluoroscopy time required to cross and total fluoroscopy time, total air kerma radiation dose, total contrast volume, and equipment use.
The investigators reported that between 2015 and 2017, 246 patients were randomized to the CrossBoss catheter (n = 122) or wire escalation (n = 124) at 11 centers in the United States. The baseline clinical and angiographic characteristics of the study groups were similar. Technical and procedural success rates were 87.8% and 84.1%, respectively, and were similar in the two groups.
Crossing time was similar at 56 minutes (interquartile range, 33–93 min) in the CrossBoss group and 66 minutes (interquartile range, 36–105 min) in the wire escalation group (P = .323) as was as the incidence of procedural major adverse cardiovascular events (3.28% vs 4.03%; P = 1.00). There were no significant differences in the secondary study endpoints.
As compared with wire escalation, upfront use of the CrossBoss catheter for antegrade crossing of coronary CTOs was associated with similar crossing time, success and complication rates, and equipment use and cost, concluded the investigators in JACC: Cardiovascular Interventions.