October 30, 2017
Use of the CrossBoss Catheter Studied for PCI of Chronic Total Occlusions
October 31, 2017—Findings from the CrossBoss First trial, which is evaluating the optimal initial strategy for crossing chronic total occlusions (CTOs) during percutaneous coronary intervention (PCI) procedures, were presented at TCT 2017, the 29th annual Transcatheter Cardiovascular Therapeutics scientific symposium being held October 30 to November 2 in Denver, Colorado.
As summarized in the TCT announcement, the study randomized 246 patients undergoing coronary CTO intervention to upfront use of Boston Scientific's CrossBoss catheter (n = 122) or wire escalation (n = 124) at 11 centers in the United States. The CrossBoss First study was funded by Boston Scientific. Overall technical and procedural success rates were high and similar between the two groups.
The primary efficacy endpoint of crossing time was similar in the two groups: 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). The incidence of procedural major adverse cardiovascular events was also similar (3.28% vs 4.03%; P = 1.00).
In the CrossBoss-first strategy, the first crossing technique was more likely to be antegrade dissection/re-entry (77%), compared with the wire escalation strategy, which was successful as the initial strategy 98% of the time among patients randomized to that study arm.
Study Chair Emmanouil S. Brilakis, MD, commented in the TCT announcement, “The CrossBoss First trial is the first randomized controlled trial designed to compare two commonly utilized crossing techniques as the initial CTO crossing strategy. Compared with a primary wire escalation strategy, upfront use of the CrossBoss catheter for crossing CTOs was associated with similar crossing time, similar success and complication rates, and similar equipment utilization and cost. In a post hoc analysis, upfront use of the CrossBoss catheter was associated with shorter crossing time in patient with in-stent CTOs. Use of antegrade dissection/re-entry was the final successful strategy in 22% of the wire escalation group patients.” Dr. Brilakis is with the Minneapolis Heart Institute in Minneapolis, Minnesota.