ChoICE™ PT wire for recanalization of chronically occluded coronary arteries:: Multiple wires in one?

Percutaneous transluminal coronary angioplasty (PTCA) of chronic total occlusions may be technically difficult and the success rate is limited despite increasing operator experience and improvements in PTCA hardware. The number of guidewires required to cross totally occluded lesions is higher than that for stenotic lesions. The ChoICE(TM) polymer-tip (PT) wire (Boston Scientific/Scimed, Inc., Maple Grove, Minnesota) is a relatively new stainless-steel core wire with a hydrophilic-coated polyurethane tip. Though never described in the literature, we found that the distal 4 cm of the wire can be cut and reshaped according to the operator's needs. Thus, instead of reshaping a kinked tip or using another new wire, the former being time-consuming and the latter expensive, one can simply cut off the kinked tip and start again with a "new wire". As the tip is resected, the wire becomes progressively more "intermediate-like" and "standard-like". We report our experience with the ChoICE PT wire in 50 consecutive cases of chronic total occlusions. The cumulative crossing success rates were 13/50 (26%) before any resections, 24/50 (48%) after 1 resection, 41/50 (82%) after 2 resections and 42/50 (84%) after 3 resections. There were no perforations, deaths, myocardial infarctions, or need for bypass surgery. Our findings suggest that successful recanalization of chronic total occlusions can be achieved with a high success rate using the ChoICE PT wire. A strategy of progressively resecting the more floppy and kinked distal end can provide multiple uses from a single wire, optimizing recanalization success and obviating the need for additional wires.