Background:
Vascular occlusions are a cause of significant morbidity and mortality in patients. Guidewires designed for chronic total occlusions (CTO) facilitate crossing occluded lesions in adults. The purpose of the present study was to review our center’s experience of recanalization of occluded pulmonary or major systemic vessels in children and adults with CTO wires.
Methods:
This study was a retrospective study of patients in whom an attempt was made to recanalize an occluded pulmonary or systemic vein or artery with a CTO wire from 1/2013 to 2/2018 in the cardiac catheterization laboratory Texas Children’s Hospital. CTO wires used included Pilot (Abbott, U.S.A), Confianza (Vascular Perspectives Ltd, UK), Victory (Boston Scientific Corp., USA), and Miraclebros (Vascular Perspectives Ltd, UK) wires.
Results:
We identified 74 patients with 94 totally occluded vessels in whom recanalization was initially attempted. Median weight of patients was 11.8 (IQR 6.45, 20.50) kg. Median age of the patients was 35 (IQR 9, 35) months. Recanalization attempts were performed on 49 systemic veins, 25 pulmonary veins, 11 pulmonary arteries and 8 systemic arteries. The Pilot wire was the most commonly used CTO wire in 39 lesions (42%), followed by Confianza in 31 (33%), Victory in 22 (23%) and Miraclebros in 2 (2%) lesions. Recanalization was achieved in 33 (67%) of systemic veins, 14 (56%) pulmonary veins, 7 (63%) pulmonary arteries, and 6 (75%) systemic arteries. Overall success rate with CTO wires was 67% and 89% when CTO wires were combined with other subsequent techniques. There were 4 (5%) minor and 2 (3%) major adverse events (1 death following pulmonary hemorrhage and 1 stroke). Freedom from re-intervention was 74% at 6 months and 53% at 12 months follow up. Seven vessels (8%) required repeat recanalization in follow up.
Conclusions:
CTO guidewires usually employed in revascularization of vessels in adult facilities, are effective and safe for recanalization of occluded pulmonary and major systemic vessels when used in Pediatric Centers. Pediatric interventional cardiologists should be familiar with recanalization techniques using CTO guidewires.