760-3 Vibrational Coronary Angioplasty Challenging Chronic Total Occlusions. Preliminary Clinical Data

Vibrational angioplasty is a novel method of angioplasty which is particularly suitable for the treatment of chronic total occlusions. Vibrational angioplasty utilises a hand held motor which is attached to a conventional catheter and guide wire. This device consists of a motor and gearing system producing a fine rapid reciprocation and random motion in a flexible guide wire. In vitro studies have shown that this system generates reciprocal motion in a guide wire with random oscillations of 2 times the reciprocating frequency. The range of movement of the wire is dependant on the frequency of vibration and degree of flexibility of the wire together with the lateral motion of the vibrating ‘shuttle’ ih the device. We present the first 18 cases (12 male 6 female, mean age 59.8 yrs range 40–73) of chronic total occlusion treated with the new version of this device. All patients had symptoms of stable angina. Arteries treated were left anterior descending:8,left circumflex:4, right coronary artery:6. In all 18 cases there was a failure to cross the lesion with conventional techniques and wires. The mean duration of the occlusions was 17.03 months (range:4–60 months). In 16/18 cases successful crossing was achieved with vibration In 2/18 cases where a wire managed to cross the lesion no balloon could subsequently cross the lesion. In 14/18 cases lesions were crossed successfully by a balloon and PTCA was performed with pressure ranging between 2.5–6 Atm. The post procedural result was: uncomplicated in 9/18, complicated by moderate dissection treated conservatively in 1/18 cases, by major dissection needed stenting in 2/18, compromised by the evidence of severe diffuse disease distally in 2/18 and regarded as unsuccessful in 4/18. The total procedural and screening times (mean±SD) were 73.2±31.3 and 41.2±16.4min respectively.In conclusion“vibrational angioplasty” appears to achieve high primary success rates in the recanalisation of totally occluded arteries. Further studies are needed to clarify its mechanism of action, the vessel wall changes due to vibrational energy and their impact on restenosis