A novel approach to the management of occlusive in-stent restenosis (ISR)

Aims: Chronic total occlusions (CTO) secondary to in-stent restenosis (ISR) represent challenging lesions with low PCI success rates. The CrossBoss is an over-the-wire blunt catheter which has emerged as a useful tool in occlusive ISR. We aimed to review the utility of this device in the treatment of occlusive ISR within the United Kingdom. Methods and results: The CrossBoss catheter was used as the primary strategy in 30 patients (31 CTOs) with a median CTO duration of 24 months, a mean CTO length of 39 mm and a previous unsuccessful PCI attempt in 48% of cases. Procedural success was 90% (27/30) and the CrossBoss catheter directly facilitated success in 81% of cases, with direct lumen-to-lumen crossing of the catheter in most cases. Identifiable predictors of failure were evident in the unsuccessful cases. When successful, crossing time was short (median eight minutes, range one to 40-minutes), as were procedural time (mean 99 29 minutes) and fluoroscopy time (mean 26.9 +/- 12.2 minutes), whilst radiation dose (median 5,738 eGycm(2), range 3,430-64,122 cGycm(2)) and contrast dose (mean 271 +/- 79 mL) were low. There were no procedural complications. Conclusions: In our experience, use of the CrossBoss catheter is associated with high procedural success rates, short crossing times and low complication rates in the setting of occlusive ISR.