No-fluoroscopy crossing of chronic total occlusions using Ocelot optical coherence tomography guided catheter.
Davis T. Vascular Disease Management 2015; 12(12): E230-E241.
Purpose: To demonstrate a case series where the use of optical coherence tomography (OCT) greatly reduced or eliminated fluoroscopy during the crossing of peripheral arterial chronic total occlusions (CTOs) when using the Ocelot catheter (Avinger). Methods: Fifteen patients were treated for peripheral arterial CTOs between January 2013 and June 2013. Sixteen lesions were attempted and crossed via the true lumen under OCT guidance using the Ocelot Catheter. Eleven males and 4 females were treated, with a mean patient age of 73 (50-91) years. Time measurements were recorded for diagnostic angiography, CTO crossing fluoroscopy, and therapeutic fluoroscopy times. Results: 100% of CTOs in this series were crossed successfully via the true lumen without the use of assist or re-entry devices. Mean CTO crossing fluoroscopy time was 0.24 (14.4 seconds) ± 0.36 minutes using the Ocelot. In comparison, mean diagnostic and therapeutic fluoroscopic times were 5.99±3.07 minutes and 14.88±6.36 minutes, respectively. Mean lesion length treated was 18.6 cm (18.63±8.58 cm). All 16 lesions were reduced from 100% stenosis to less than 10% stenosis. The treated lesions represented a spectrum of calcification (mild/none=2; moderate=8; severe=6) The mean contrast volume administered across all procedures was 176.66±50.08 mL (median=180; range 100-230 mL). There were no adverse events reported at 9-month follow-up. Conclusion: The Ocelot catheter allows for safe, quick, and efficient crossing of peripheral arterial CTOs while eliminating, or significantly reducing, fluoroscopic exposure and associated contrast administration.
Key words: chronic occlusion, peripheral vascular disease, superficial femoral artery, atherosclerosis, vascular disease