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Heart Care Specialty Updates

May 2017

Advances in guide wire technology improve outcomes

New guide wire technology used in retrograde angioplasties for chronic total occlusions has improved patient outcomes, providing outcomes similar to those produced by the more commonly employed approach to angioplasty, University of Minnesota Health Heart Care interventional cardiologists report. Retrograde angioplasty is used when the proximal “cap” end of the occluded segment is too unfavorable or too hard to pass wires or catheters through using antegrade approaches. The approach is the preferred option for a reported 25% of chronic total occlusion cases1, although before the advent of new tools and techniques, it had been considered a higher-risk approach.

Special steering technology in the new guide wires allows them to be passed from an adjacent coronary artery through microscopic collateral arteries that have formed in response to the diseased heart’s need for oxygen. The M Health Heart Care providers are recognized as experienced in the approach to angioplasty.

An established device finds use in addressing CTOs

An earlier device employed in addressing chronic total occlusion (CTO) gains new favor in the treatment of complex cases of the condition. Advances in guide wire technology have allowed interventionists access to challenging occlusions, inspiring a reconsideration of the method known as percutaneous excimer laser coronary atherectomy (ELCA) for use in the most difficult cases. Previously considered more expensive and less safe than other methods, ELCA is now being called into action after other approaches fail to create a channel wide enough to allow entry of a balloon catheter.2 Employed in these cases, the laser catheter of ELCA technology can slowly dissolve the plaque, creating a widened channel for occlusion-removing tools.


  1. Tamburino C, Capranzano P. Retrograde approach for chronic total occlusion percutaneous coronary intervention: The paradox of choice. Circ Cardiovasc Interv. 2016;9(6):e004023.
  2. Azzalini L, Ly HQ. Laser atherectomy for balloon failure in chronic total occlusion. Int Heart J. 2014;55:546-549.
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