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Cardiovascular Engineering and Technology

, Volume 7, Issue 2, pp 103–117

First Online: 01 February 2016Received: 12 August 2015Accepted: 12 January 2016DOI: 10.1007-s13239-016-0255-0

Cite this article as: Sakes, A., Regar, E., Dankelman, J. et al. Cardiovasc Eng Tech 2016 7: 103. doi:10.1007-s13239-016-0255-0


Chronic total occlusions CTOs represent the -last frontier- of percutaneous interventions. The main technical challenges lies in crossing the guidewire into the distal true lumen, which is primarily due to three problems: device buckling during initial puncture, inadequate visualization, and the inability to actively navigate through the CTO. To improve the success rate and to identify future research pathways, this study systematically reviews the state-of-the-art of all existing and invented devices for crossing occlusions. The literature search was executed in the databases of Scopus and Espacenet using medical and instrument-related keyword combinations. The search yielded over 840 patents and 69 articles. After scanning for relevancy, 45 patents and 16 articles were included. The identified crossing devices were subdivided based on the determinant for the crossing path through the occlusion, which is either the device straight and angled crossing, the environment least resistance, tissue selective, centerline, and subintimal crossing or the user directly steered and sensor enhanced crossing. It was found that each crossing path is characterized by specific advantages and disadvantages. For a future crossing device, a combination of crossing paths is suggested were the interventionist is able to exert high forces on the CTO as seen in the device approach and actively steer through the CTO user: directly steered crossing aided by intravascular imaging user: sensor enhanced crossing or an intrinsically safe device following the centerline or path of least resistance environment: centerline crossing or least resistance crossing to reach the distal true lumen.

KeywordsChronic total occlusions CTO Crossing Percutaneous coronary intervention PCI State of the art Treatment Recanalization Review Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Author: Aimée Sakes - Evelyn Regar - Jenny Dankelman - Paul Breedveld


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