* NIBBLERS (ie. mechanical jaws)
https://www.cumedicine.us/about-cu-medicine/health-insights/new-cu-medicine-vascular-surgery-clinic
“Newer plaque removal procedures such as modified peripheral laser atherectomy,
which uses a laser to unblock arteries, can allow minimally invasive treatment
of total artery blockages without open surgery.”
https://cordis.com/na/products/cross/endovascular/frontrunner-xp-cto-catheter
https://www.medicalexpo.com/prod/cordis/product-71108-450338.html
“The FRONTRUNNER® XP CTO Catheter enables controlled crossing of Chronic Total Occlusions (CTOs), using blunt microdissection to create a channel through the occlusion to facilitate wire placement.”
What really bugs me is many of these studies are over a DECADE OLD !!!
Also check out the “Similar Articles” –
I didn’t get to them all – but maybe not necessary.
https://pubmed.ncbi.nlm.nih.gov/23813063/
“Objective:
The purpose of this study was to examine the safety and efficacy of the Frontrunner
XP CTO (chronic total occlusion) catheter (Cordis Corporation) for recanalization
of CTO of femoropopliteal arteries.“
“Results:
Twenty-two of the 33 cases (66.7%) had failed previous attempts of percutaneous intervention with conventional guidewire.
The Frontrunner catheter was used to treat 22 CTOs after guidewire failure.
The Frontrunner catheter successfully facilitated the placement of a guidewire into the distal true lumen in 21 cases (95.5%).”
https://pubmed.ncbi.nlm.nih.gov/19777300/
“Abstract:
In conclusion, recanalization with the Frontrunner CTO catheter is a simple and safe method with a high technical success rate in the endovascular treatment of long superficial femoral artery occlusions and should be an alternative method after guidewire failure.”
https://pubmed.ncbi.nlm.nih.gov/22975332/
“Wildcat” catheter …
“Conclusions:
In this multicenter study, the Wildcat catheter demonstrated an 89% crossing success rate with little associated morbidity. The Wildcat catheter is a viable device for crossing moderately calcified femoropopliteal CTOs.”
https://pubmed.ncbi.nlm.nih.gov/32082770/
“Conclusion:
The use of a crossing catheter showed a high rate of technical and procedural success
in infrapopliteal chronic total occlusions without significant complications.”
LASERS
I like the “vaporize it into it’s sub-atomic particles!” (not really, but close LOL) –
no leftovers to clog capillaries
https://www.ramed.com/vascular-us/
The marketing isn’t talking about “no guidewire”, but:
“Safety. DABRA is designed to track the patient’s true lumen, or the center of the artery, and not to penetrate between the layers of the arterial structure known as the subintimal space. No serious device-related adverse events were reported in our 2017 pivotal study.”
Here we have “one of your peers” talking about it.
“When it comes to total occlusion, normally if you can’t cross with a guidewire, you can’t do it.
With DABRA, we were able to stay within the true lumen and recanalize without a wire in front.”
Ehtisham Mahmud, MD – FACC, FSCAI
UC San Diego Cardiovascular Clinic
ISSUES: Recall and internal procedures – but the FDA is still letting them run – for whatever that’s worth ROFL
https://www.massdevice.com/internal-probe-finds-major-problems-at-ra-medical/
Active Study!!! They’re looking for 25 more patients.
https://www.massdevice.com/ra-medical-enrolls-100th-patient-in-clinical-study-of-dabra-laser-system/
* These Philips lasers seem to need a wire –
but I don’t (yet) know if that’s just to “get it close”
https://www.usa.philips.com/healthcare/product/HCIGTDTRBELSRA/turbo-elite-laser-atherectomy-catheter
“Cross and debulk with one device
The safe and proven step-by-step method crosses and prepares challenging occlusions without a wire by acting directly from the catheter’s tip.³” <<<<<<========== WITHOUT A WIRE
This seems to be “coronary” — but if it’s good in those little vessels, should be good for those big leg arteries. 🙂
https://www.usa.philips.com/healthcare/product/HCIGTDELCALASR/elca-coronary-laser-atherectomy-catheter
* No idea at this time if this device might be applicable
https://www.bd.com/content/bd-com/na/us/en-us/products-and-solutions/products/product-families/crosser-iq-ultrasonics-cto-device.html