The Heartrail system (Terumo, Tokyo, Japan) is available in 5-Fr, 6-Fr, and, 7-Fr sizes.
The Guidezilla (Boston Scientific, Natick, MA, USA) has a hydrophilic coating with a polymer-coated metal collar to facilitate device insertion and is only available in a 6-Fr size. IMDS produces the Guidion (IMDS, Roden, Netherlands) catheter which has a more flexible atraumatic distal end. Various companies have implemented guiding catheter extensions in their portfolio to overcome the problem of a poor backup support. Additionally, the use of stiffer wires, the anchoring balloon technique, and deep intubation of the guiding catheter may be applied to improve the backup support. Regardless of the clinical setting, an enhanced backup provides one of the most important preconditions to ensure guide wire and balloon advancement and stent delivery, thereby enabling a successful percutaneous coronary intervention (PCI). Ī strong and stable backup of the guide catheter is essential to advance guidewires, balloons, and stents over the lesion in highly calcified and tortuous vessels. If significant myocardial ischemia exists combined with clinical symptoms due to ischemia, recanalization is indicated left ventricular function can be improved, more invasive therapies like coronary artery graft surgery can be avoided at lower complication rates, and even the prognosis of the disease can be improved in suitable cases with both a short-term and long-term survival benefit. In experienced hands, reopening rates exceed 85%.
Due to new interventional techniques and the use of further advanced sophisticated materials, success rates of CTO recanalization increased steadily in recent years. A CTO of a coronary artery can be identified in up to 30% among patients with a clinical indication for coronary angiography. Recanalization of chronic total occlusions (CTO) remains a challenge in interventional cardiology.
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