At the 2012 VEITHsymposium, John R. Laird, MD, gave a presentation on the mechanism and efficacy of the TruePath CTO Device (Boston Scientific) for crossing chronic total occlusion (CTO) lesions. The device features a diamond-coated distal tip that rotates at 13,000 revolutions per minute. Vascular Disease Management spoke with Dr. Laird about the device.
Editor's note: View video of this interview at "The TruePath CTO Device: An Interview With John R. Laird, MD."
Q: What are the specific benefits of the TruePath Device in comparison to other devices?
A: The TruePath device is designed like some other CTO devices to allow you to remain intraluminal as you cross the CTO rather than going subintimal. The benefit of this device compared to other devices is that it acts and feels just like a standard guidewire, an .018-inch guidewire, but the tip spins at 13,000 RPMs, so it has the ability to bore through harder plaque and more calcified plaque and potentially increase success rates for crossing difficult chronic total occlusions.
Q: Are there any limitations to the TruePath device?
A: Like a lot of these “intraluminal devices,” if you already have tried to cross the occlusion with another guidewire and you create a subintimal dissection, or subintimal plane, the TruePath is likely to follow that same path into the subintimal space. So, to be successful with the device, you have to either start out with it or be a little bit more careful with wires you use before this device.
There are also limitations as to how well you can steer the device, because you can only put a 15-degree bend on it, so you may need to use the device in conjunction with an angled support catheter. And for extremely calcified lesions, you may not have enough drill power to get through that hard proximal cap.
Q: Can you share a case example of a patient in whom this worked very well?
A: I have used this in a number of scenarios and I have had cases where it really did make a difference. One memorable case was where I was treating an SFA occlusion, about a 10-cm-long occlusion in a segment of diffuse disease and I was able to cross the occlusion very easily in a few minutes with the TruePath device, and then my assistant accidentally pulled the wire out and at the same time contaminated it so it couldn’t be used again, and so I was left to try to recross the occlusion with a standard guidewire and it actually took me about 45 minutes and a great deal of difficulty to get back through the CTO.
For me, that highlighted the benefits of the product because otherwise you never really know whether you could have crossed as well or as easily with some of the usual guidewires and usual techniques.
We’ve also had a few cases of infrapopliteal CTOs where we crossed very easily and very nicely with this device after struggling with some other guidewires.
Q: What is the most important take-away message about this device for vascular specialist?
A: I think for all of us, it’s still a learning experience. We’re still trying to figure out where best this technology can be applied. But like a lot of these intraluminal CTO devices, you have to be patient, you have to take your time, and you have to allow your device to do its work rather than trying to push hard and move quickly, or you’re going to end up subintimal like you would with any of the other standard guidewire techniques, so patience is required.
John R. Laird, MD, is a medical director and professor of medicine at UC Davis Vascular Center in Sacramento, California. His practice focuses on interventions for carotid artery disease, abdominal and thoracic aortic aneurysmal disease, renal artery disease, and peripheral artery disease. Dr. Laird reports board membership at VIVA Physicians; consultancy to Boston Scientific, Bard Peripheral Vascular, Covidien, Abbott Vascular, and Medtronic; grants from W.L. Gore and Atrium Medical; and honoraria from Volcano Corporation.