Guidewires in the Treatment of Chronic Total Coronary Occlusions

l l Purpose: To study the efficacy and safety of vibrational angioplasty versus hydrophilic guidewires for recanalizing chronic total occlusions (CTOs) of the coronary arteries. Methods: In a retrospective study, 99 patients with old (.3 months) CTOs resistant to conventional techniques were treated either with vibrational angioplasty (group A, n 5 72) or 0.014-inch hydrophilic guidewires (group B, n 5 27). The selection of the technique (vibrational angioplasty or hydrophylic guidewires) was dependent only upon device avail-ability. A variety of guidewires were employed in conjunction with vibrational angioplasty. Results: The crossing success rates in groups A and B were 86.1 % (62/72) and 55.5 % (15/ 27) (p, 0.05), with final procedural success rates of 75 % (54/72) and 44.4 % (12/27) (p, 0.01), respectively. The main reasons for failure were inability to cross the lesion with a guidewire (10/18 in group A and 12/15 in group B) and large dissections resulting in vessel closure (2/18 in group A and 2/15 in group B). Three major complications were seen, 2 in group A and 1 in group B. Three vessel perforations were reported in group A. Both tech-niques needed prolonged fluoroscopy times. Conclusions: Vibrational angioplasty was more successful in treating CTOs compared to hydrophilic guidewires and had similar complication rates (most without clinical sequelae)