Development of a novel calcified total occlusion model in porcine coronary arteries.

Abstract

OBJECTIVE: The objective of this study was to create a calcified total occlusion model in porcine coronary arteries using a catheter-based technique. BACKGROUND: Chronic total occlusion (CTO) represents 10-20% of all angioplasty cases and remains a challenge for interventional cardiologists. One of the limitations to successful recanalization is the failure to cross the wire through the CTOs. METHODS: Twenty swine underwent total occlusion creations in the coronary arteries. Via a carotid artery, previously prepared bone chips with absorbable sponge were delivered into the coronary arteries using catheter-based techniques. Twenty-eight days post creation, coronary angiography and histology were performed. RESULTS: Twelve animals survived and 10/12 had successful total occlusions. There were successful total occlusions in 100% (8/8) of the left anterior descending coronary arteries in the animals that survived. Angiography showed visible calcified total occlusions under fluoroscopy and also showed bridge collaterals distal to the occlusions (4/8) or contralateral collaterals from the right coronary arteries (4/8). The histology showed calcified nodules and abundant microchannels within the occlusions, media, and adventitia. CONCLUSIONS: We could successfully create a reliable and repeatable porcine coronary model of calcified total occlusions. This method can be utilized in many preclinical evaluations of CTO technologies.