CrossBoss First: Antegrade Dissection and Re-Entry vs. Standard Wire Escalation for Crossing Coronary Artery CTOs

Upfront use of the CrossBoss catheter for antegrade crossing of coronary chronic total occlusions was associated with similar crossing time, similar success and complication rates and similar equipment utilization and cost, compared to wire escalation, according to researchers presenting on the CrossBoss First trial at TCT 2017. The findings were also published in JACC: Interventions.

The study randomized 246 patients between 2015 and 2017 to CrossBoss (n=122) or wire escalation (n=124) at 11 centers in the U.S. Baseline and clinical angiographic characteristics of both groups were similar. The mean patient age was 65.5, 82 percent of patients were men, 37 percent had diabetes mellitus and 26 percent had prior coronary bypass surgery. The primary endpoints were time required to cross the chronic total occlusion or abort the procedure, and the frequency of procedural major adverse cardiovascular events. Researchers also assessed secondary endpoints related to technical and procedural success, total procedure time, fluoroscopy time required to cross and total fluoroscopy time, total air kerma radiation dose, total contrast volume, and equipment utilization.

Results showed technical and procedural success were 87.8% and 84.1%, respectively, and were similar in the two groups. Crossing time, the primary endpoint, was also similar at 56 minutes in the CrossBoss and 66 minutes in the wire escalation group (p=0.323). Researchers noted that post hoc subgroup analyses showed upfront use of the CrossBoss was associated with shorter crossing time than wire escalation in CTOs due to in-stent restenosis, but "there was no difference in short (<20 mm) or longer (≥20 mm) lesions, lesions with and without proximal cap ambiguity, moderate or severe calcification, and moderate or severe tortuosity."

"The post hoc subgroup analysis needs to be viewed as a preliminary finding, given there was no overall difference in the primary endpoint," said ACC.org Editor-in-Chief Kim Eagle, MD, FACC.

Incidence of major adverse cardiovascular events were also similar across the CrossBoss and wire escalation groups at 3.28 percent vs. 4.03 percent, respectively. Additionally, researchers did not find any significant differences in other secondary endpoints, including equipment utilization and equipment cost.

What's next? Researchers suggest "new devices and crossing techniques are needed to further improve the success rates and procedural efficiency and reduce the complication rates of coronary chronic total occlusion interventions."



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