Randomized Comparison of a CrossBoss First vs. Standard Wire Escalation Strategy for Crossing Coronary Chronic Total Occlusions: the “CrossBoss First” trial

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Minneapolis Heart Institute Foundation Researcher, Dr. Manos Brilakis presented a first report investigation from CrossBoss First: A Randomized Trial of Antegrade Dissection and Re-entry vs Standard Wire Escalation for Crossing Coronary Artery Chronic Total Occlusions at the Transcatheter Cardiovascular Therapeutics conference in Denver, CO last week.

The goal of the trial was to assess the safety and efficacy of using a CrossBoss catheter versus antegrade wire escalation for antegrade wire crossing of chronic total occlusions (CTOs). This trial showed that using a CrossBoss microcatheter upfront versus antegrade wire escalation has similar procedural success, procedure times and equipment costs among patients undergoing antegrade CTO percutaneous coronary intervention (PCI).

Patients with a CTO undergoing an antegrade wire crossing attempt were randomized in a 1:1 fashion to either initially attempt CTO crossing using the CrossBoss catheter or using antegrade wire escalation. Randomization was stratified by Japan Chronic Total Occlusion (J-CTO) score and by site. The study screened a total of 966 and enrolled 246. The enrollees were followed for 1 year.

Brilakis summarized the findings in an interview with Peter Block at TCT: “There are 3 take-home messages. The first one is that whether you start with the guide-wire or the CrossBoss, you are going to be equally successful and have similar crossing time. Number two: in the case of in-stent restenosis, the CrossBoss has the advantage. And lastly, it’s safe, and you have to have this technique because you will need it in a quarter of case.”  View the full video interview above. These findings were published in Journal of the American College of Cardiology.

Coronary artery chronic total occlusion (CTO) is complete or almost complete blockage of a coronary artery for 30 or more days. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery. Traditionally, most patients with CTO with symptoms required coronary artery bypass graft (CABG) surgery to clear the blockage. In the past, total blockages of the coronary artery have been difficult to clear with interventional procedures. However, with the advent of advanced technology and innovative percutaneous (performed through a needle stick through the skin) techniques, interventional cardiologists are improving the outcomes of percutaneous coronary intervention (PCI), making it a viable option for some patients who are experiencing symptoms related to their CTO. Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. New technology makes fine movement of the guide wire tip much easier to control than in the past.

About the Minneapolis Heart Institute Foundation®

The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.

  • Scientific Innovation and Research — MHIF is a recognized research leader in the broadest range of cardiovascular medicine and population health initiatives. Each year MHIF leads more than 175 active research projects and publishes more than 175 peer-reviewed abstracts. Cardiologists, hospitals and communities around the world adopt MHIF protocols to save lives, improve care and create healthier living opportunities.
  • Education and Outreach — MHIF provides more than 10,000 hours of education each year putting its research into practice to improve outcomes. And, MHIF leads cutting-edge, transformative population health research to connect, engage, inform and empower individuals and communities to improve their health.

The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and supports research initiatives of Minneapolis Heart Institute® at Abbott Northwestern Hospital.  Minneapolis Heart Institute® physicians provide care for patients at Abbott Northwestern Hospital in Minneapolis and at 38 community sites across Minnesota and western Wisconsin.