BelowtheKnee CTOs Crossing from Above with Wires and

Below-the-Knee CTOs – Crossing from Above with Wires and Devices Rajesh Malik MD, FACS Associate Professor of Surgery, Med. Star Georgetown University

Rajesh Malik MD I have no relevant financial relationships

• 40 -50% of the some practices patient populations have CTOs • This could make it difficult to complete the procedure endovascularly and could require surgical bypass or possible amputation

CTO Wire Based Subintimal Crossing Catheter True Lumen

Understanding the CTO Anatomy Mustapha et al, Endovascular today May 2014

George et al

Crossing Devices

Truepath • Micro-dissection via diamond-coated tip spinning at 13, 000 rpm • 165 cm length, 0. 017” tip profile

Crosser • Utilizes high-frequency mechanical vibration • OTW and rapid exchange systems • Takes patience, i. e don’t keep aggressively pushing the system

Frontrunner XP • Catheter steerability • Profile of. 039” with 2. 3 mm jaws • Hydrophilic coating

Viance • No capital equipment • Can regulate catheter’s spinning motion that helps to direct tip and provides feedback • OTW 0. 014” guidewire compatibility • Working length 150 cm

Ocelot • OCT imaging on the tip of a rotating catheter • Rotational speed 30, 45, 60 rpm • OTW compatible with 0. 014” wire

Conclusion • Many different ways to cross a lesion • Understanding the CTO anatomy may help facilitate using the most efficient method.