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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 when using the Ocelot catheter (Avinger, Redwood City, CA).
Materials and Methods: Fifteen patients were treated for peripheral arterial chronic total occlusions (CTO) between January 2013 and June 2013. Sixteen lesions were crossed using real-time OCT as the primary imaging modality in these cases. The mean patient age was 73 years (range, 50-91 years). Ten males and 5 females were treated. Radiographic values measured included diagnostic angiography, CTO crossing fluoroscopy, and therapeutic fluoroscopy times.
Table 1. Characteristics of Case Series Demographics, Lesions and Fluoroscopy Times
Results: One hundred percent of CTOs in this series were crossed successfully via the true lumen without the use of assist or reentry devices. Mean CTO crossing fluoroscopy time was 0.24±0.36 minutes (14.4±21.6 seconds) using the Ocelot (Figure). 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). 16/16 lesions were reduced from 100% stenosis to less than 10% stenosis. In 15/15 cases, the mean contrast volume administered across procedures was 176.66±50.08 mL (median, 180 mL; range, 100-230 mL). There were no adverse events reported at 60 days.
Figure 1. Measured Fluoroscopy Times
Conclusion: Lumivascular techniques allow for safe, quick, and efficient crossing of peripheral arterial CTOs while eliminating or significantly reducing fluoroscopic exposure and contrast administration.