Cath Lab Digest

*NOTE: Click on the image above to view a video clip of the CrossBoss

JM is a 70 year-old gentleman who has had coronary disease for 20 years. He presented with angina pectoris and inferior ischemia on stress Myoview. He has had previous bypass surgery with a patent internal mammary to the ramus intermedius and a patent left anterior descending artery (LAD) bypass saphenous vein graft. His right coronary artery (RCA) has been occluded for at least 5 years and his left ventricular function is fair, with an ejection fraction of 50% with mild hypokinesis of the inferior wall.

In 2006, he had stenting of the proximal portion of the RCA, but the distal RCA could not be recanalized. He then underwent PTCA of the RCA. An 8 Fr JR4 guide with side holes was placed. Angiography showed the total occlusion (Figure 1). As part of the FAST CTO trial, attempted recanalization of the RCA was performed with a Fielder XT (Asahi Intec/Abbott Vascular, Redwood City, California) without success. After 10 minutes of fluoroscopy time as required in the FAST CTO trial, we placed the CrossBoss™catheter (BridgePoint Medical, Plymouth, Minnesota) over the Fielder XT wire. The CrossBoss™ was able to be successfully recanalized across the CTO within a few minutes of fluoroscopy (Figures 2, 3 and 4). We passed the Fielder FC in the distal vessel and exchanged it for a 2.0 x 10 cm over-the-wire Sprinter balloon (Medtronic, Inc., Minneapolis, Minnesota), and IVUS showed the proximal vessel to be diffusely diseased throughout the course of the entire vessel. The mid-portion of the RCA could not be passed with the Eagle Eye® IVUS catheter (Volcano Therapeutics, Inc., San Diego, California). Because of the diffuse nature of the disease, we performed balloon angioplasty with a 3.0 x 3 cm balloon over the length of the vessel. A total of 5 Xience™ drug-eluting stents (2.5 x 18, 2.75 x 28, 3.0 x 28 and 3.5 x 28) (Abbott Vascular, Abbott Park, Illinois) were placed. The flow following the procedure was excellent (Figure 5).

This represents a case of the use of the CrossBoss™catheter. We find the CrossBoss™ catheter to be quite flexible, and unlike other CTO devices which are just support catheters, this actually can be used in front of the wire effectively with its hydrophilic tip bouncing off and staying in the true lumen.

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Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI, is an internationally recognized cardiologist, inventor, educator and author. A diplomate of the American Board of Cardiovascular Diseases and the American Board of Interventional Cardiovascular Diseases, Dr. Heuser is one of the early pioneers of angioplasty and is considered one of American’s top cardiologists. Dr. Heuser is currently in practice at the Phoenix Heart Center/Physicians Group of Arizona. He is Director of Cardiology and Chief of Cardiac Catheterization Laboratory at St. Luke’s Hospital and Medical Center, Phoenix, Arizona, and Clinical Professor of Medicine at the University of Arizona College of Medicine, as well as Director of the Interventional Fellowship Program at the University of Arizona College of Medicine, Phoenix Campus.

With 13 patents granted for different catheters stents and other medical devices, Dr. Heuser has served as a principal investigator to research the safety and/or effectiveness of more than 100 medical devices and 50 pharmaceutical products, and has participated in more than 20 research studies. He has authored numerous articles, textbooks and medical manuscripts, and is frequency invited to international medical conferences to present findings of research developed in Phoenix.

Dr. Heuser received his medical degree from the University of Wisconsin School of Medicine in Madison, Wisconsin, and completed his medicine internship and residency, as well as his cardiology fellowship, at the Johns Hopkins Hospital in Baltimore, Maryland.
Richard R. Heuser, MD, FACC, FACP, FESC, FASCI, is an internationally recognized cardiologist, inventor, educator and author. A diplomate of the American Board of Cardiovascular Diseases and the American Board of Interventional Cardiovascular Diseases, Dr. Heuser is one of the early pioneers of angioplasty and is considered one of American’s top cardiologists. Dr. Heuser is currently in practice at the Phoenix Heart Center/Physicians Group of Arizona. He is Director of Cardiology and Chief of Cardiac Catheterization Laboratory at St. Luke’s Hospital and Medical Center, Phoenix, Arizona, and Clinical Professor of Medicine at the University of Arizona College of Medicine, as well as Director of the Interventional Fellowship Program at the University of Arizona College of Medicine, Phoenix Campus.

With 13 patents granted for different catheters stents and other medical devices, Dr. Heuser has served as a principal investigator to research the safety and/or effectiveness of more than 100 medical devices and 50 pharmaceutical products, and has participated in more than 20 research studies. He has authored numerous articles, textbooks and medical manuscripts, and is frequency invited to international medical conferences to present findings of research developed in Phoenix.