Chapters Transcript Video A Physician’s Journey with the Crosser™ iQ CTO Recanalization Catheter Duration: 13:42 minutes In this interview, Interventional Cardiologist, Dr. Ian Cawich discusses how he became a believer in the Crosser™ CTO Recanalization Catheter. He also describes how easy the system is to set up, use and reviews a case. Good afternoon, everyone. My name is Lyle Branch and I'm an associate with Beatty. I'm joined today with Doctor Ian CIC from Arkansas heart out of uh Little Rock, Arkansas, Doctor Kowitz. Thank you for joining us. Thank you for having me. Awesome. So, we're here today to talk about Crosser IQ. So can you actually talk to us about your journey into actually using Crosser? Absolutely. So, um at the start of my practice, uh when, when I got out of fellowship, you know, I, I looked at crossing devices as well as just, you know, the manual using a wire and a support catheter. And there were several court cases that I couldn't cross with just a wire and support catheter. And I knew there was some success with Crosser Legacy at that time. Um And so I talked to my rep and I was able to arrange to go down and actually went down to Miami uh Florida and work with uh Bob Beasley. Uh and he was initially the one that trained me to work with uh cross her legacy. And uh we did use Cross her legacy for, for a bit, for several cases. And for several uh couple of years. Um but, you know, um as, as my skills progressed, we kind of backed off a little bit of cross legacy and to be honest with you also, the set up was a little more uh tedious with cross her legacy. And so as the staff would change and we'd have to retrain people. And so we had a, a little bit of a lag as far as with the set up of Crosser legacy that, you know, we kind of drifted away a little bit from it. Um uh This changed quite a bit once. Uh Beatty introduced the Crosser, the new Crosser, which is the Crosser IQ. Um So we had uh worked a little bit with them as far as uh trying to see some of the modifications that changed, you know, things that they, some of the power adjustments they had made to the Crosser IQ to enable it to stay uh Luminal um to allow it to, you know, uh work more on the, on the calcified tissue and as well as, you know, the ease of setup. And so when BD finally launched Crosser IQ, we were able to um you know, bring it into the lab and realize how easy it is to set up as far as, you know, just putting, turning on the console and hooking up an IV and then just uh testing device on the field, we realized how that it didn't delay us, it's almost as quickly as putting a support catheter. And so we kind of went back to using Cross or IQ, especially in the, in the difficult cases that have moderate to severe calcium, which most chronic total inclusions occur. Um And so one of the things that we did was we realized that, you know, it's as far as going from a something that, you know, we had to wait or, or hear the moans and groans in the catalog about setting up the Crosser legacy. All of those things got better with the Crosser IQ. We were then able to uh incorporate the Crosser IQ into our algorithm for crossing total inclusions um Both in the S fa as well as below the knee. Um Probably 11 of my biggest uh I shouldn't say my biggest surprises. One of my biggest uh concerns that I had with sometimes crossing devices is going subintimal. And I was quite pleasantly surprised at how much the crosser IQ keeps you Luminal. And so the first, probably five case, 5 to 10 cases that we did uh with the Crosser IQ, we also did intravascular imaging. And there were a lot of cases where I thought I felt like, oh, you know, I definitely went subintimal uh soinam and, you know, I definitely, you know, probably can't use Atherectomy with this and realized that once we put the intravascular imaging that we were transluminal, that we were intraluminal, the whole way. And so even though um it looked at the reconstitution site that we were possibly hadn't re entered at the, at the cap, um what actually happened was we entered into the plaque, so we still stayed Luminal and just entered into the open vessel a little bit distally, but you still could be able to treat the plaque that you at the, at the crossing at the distal cap. And so for me, um my algorithm for using Cross or IQ, I think it's one of the best places for your cross or IQ. For me, um a heavily calcified vessel which in the past, I would have had to use a prolapse wire and then usually try to re enter or come from below to try to create another dissection tract and try to cross these, most of these lesions, you know, would then I have require stenting because we would be lo they have a lot of dissection planes. And I have a lot of trans uh you know, a lot of uh dissection flaps and we'd be subimal. Most of these cases were then able to be allowed to be able treated with a ay and angioplasty and not, not that straightforward requirement for having stenting. But uh so that's kinda where my progression has become from, from using Crosser Legacy, went away from Cross Her Legacy some and now with Cross her IQ, both the E A set up the, the how much it the fact that it does cross mostly Luminal or where just a wire and a support after it won't work. That actually uh it provides a good Ar Armenta for me to be able to use the device. Well, thank you so much. Now, you talked about the ease of use uh and the ease of set up. Can you explain uh what that difference was between the legacy Crosser and Crosser? I, you. So, and to be honest with you, I never quite learned how to set up the Crosser Legacy because it was much more cumbersome, uh filling up the pump and then setting up everything. In fact, the, the cases, the, the days that we knew we were gonna use the Crosser, we would have the, the, the sales rep come in and set up the device in the morning because most of the staff wouldn't know how to use it or set it up and then we would be still be able to use it during the day. Now, the Crosser IQ once that was able to, we were able to uh incorporate that into our lab, it was so easy that even I could guide them in how to do it. Um Because again, uh it's just the, it's just the uh console and you turn on the console, uh you attach a flush to the console and then that's what gets attached to the catheter and that's you plug in the catheter and that's pretty much all the set up it requires as far as for you, for you to be able to use it. That's amazing. Now, you also talked about staying true lumen. Can you explain to us why that's important? And can you also uh go into details about how fast you're actually able to cross these lesions now that you have cross your IQ in your algorithm. So for, for me and there are some studies that show that's crossing Luminal versus crossing sinal that your outcomes are better. Uh But for me, it because you're able to stay Luminal, you're able to open up a whole other uh array of things that you ways you can treat the artery of things that you could treat your patients with. Uh For me, once you cross the mole, you almost have required to stent because you, you went into a flap, you re entered. If you don't treat with a stent, then that area is uh is almost definitely closing for me. If once I cross Lalli, then I know that I can treat with Arar toy you can either use. Uh So you can use something as uh the rotor X, you can use one of those ar devices safely. Uh There are other devices out there that treat calcium that you can, you can use alternatively, especially if it's a severely calcified vessel. Um That again, if you cross luminary, you're able to treat the entire vessel and, and cause some uh you know, and, and treat black modification. My results using crosser IQ and crossing these moderately severe uh uh uh chronic total occlusions is that I'm usually will treat them, uh treat them with ar and then followed by A L anoplasty, but it really uh decreased my use of having to put in some stent implant. Um And again that, you know, long term, I think field may be beneficial to my patients. So the, the fact that you can cross luminary and as well as you open up that you can do atherectomy and need for, for immediate stenting. I think those are the big pluses why I see that a device like this is helpful. Um a lot of times we don't realize that when we uh cross with just a wire and a support catheter that we may go subintimal and then re enter and again, those, those are not cases that you want to be using a Toomy in. Um and those cases you almost have to always have to end up stenting. And so to me that's uh it limits what I can offer and do for my patients. Um The way the device works is, you know, uh we put the device right at the, at the cap and then we just let the device sit there and, and what eventually happens is if we need to, we put a little bit of gentle pressure. But for the most part the device will create enough uh create enough based on its mechanism of action to be able to enter the CTO. And then with a little bit of gentle pressure, you're able to cross the CTO. And for the most part, again, where I've had to, um you know, I'm not able to advance the wire or support catheter or not crossing device. Then we end up pushing a prolapse glide and then we enter into subintimal and go past the distal cap and we have to get pedal access or get a Rry device and then come from below and create a go sub intimately again, balloon, angioplasty. Do you know? And then finally, we were able to cross, I think that adds, you know, 2030 minutes to your case. Whereas, you know, when we've used this in those times, we feel like we just have need a little bit of something to, to cross or to start, we were able to cross the CTO si think for as far as uh people that come in and help with do these uh with these cases to see these cases. And some of the staff, sometimes they're pretty, they're always uh when we get stuck, they're always saying we should, let's just get to cross her IQ or let's just cross her IQ it because again, it allows you to be able to cross these devices in a quicker manner and be able to move on to treating, move on able to finishing with the patient and you know, the lab time, you know, and staff time is always what's the most expensive thing. And so for us, if we are able to cross and treat and be done with the case, we can move on to the rest of the cases improves the flow of the lab. And so overall, it reduces the cost of what the institution will bear. Thank you so much. Now, you also have an amazing case uh here with us today. So could you actually walk us through this case? And again, talk to why you chose cross IQ for this specific case and what those outcomes actually were. So the case is based essentially a right superficial femoral artery, uh popliteal chronic total occlusion. And you can see on the on the angiogram that it is actually a rather long total occlusion. Um but there is a, there is a nice proximal um tract where, you know, it is heavily diseased, but it does have a flush cap. And again, so here what we'll do is we'll bring the support catheter, we'll uh use the wire to advance a little bit. But once we put this the crosser it at the proximal cap, so it does and go sub and then we just slowly advance the crosser until we get to the distal cap. And then once we feel like we're past the distal cap, then the wire, there's a wire looming inside the crosser and we're able to advance the wire freely. And so you see that the reconstitution on this slide is down in the public teal. And so now we can see that this is as this is post crosser. And you can see that there is some channels there, there's an areas now that you could see that we're open, that we're able to, you know that, you know, we're just hibernating. And then after this was just after rotor x after and balloon angioplasty, you see that we have great results. As far as there's not a need for stenting, there's no dissection flaps. And so then our final results again show that, you know, we're able to treat this patient with just atherectomy and get good results as far as for patients outcomes. That was an amazing case. Now, doctor Cowage, what would be some parting words that you have for anyone that might be hesitant to try cross re you uh at least in my, in my uh experience, it's been that, you know, I felt a lot of times that I was able to just cross, you know, using a support catheter and a wire realized that, you know, a lot of times I was having to uh come from an alternative access to cross the uh device or having to use some adjunctive reentry device. And then again, at that point, I was limiting myself in what I could offer my patients. I found that in these cases, crosser actually works very well. Um It works well again and, and also in, in, in uh chronic total occlusions that don't have any significant calcium, but the most, the most difficult of the chronic total occlusions, they severely calcified. I feel that that is a great tool to be able to save you time. Cross it increases your success rate and still keeps you with uh open all the options open that you wanna be able to offer and treat the patient with Doctor Kowitz. Thank you so much for your time. Thank you for walking us through your journey. Thank you for walking us through the ease of use and the ease of setup and the crossing time and then also showing this uh amazing case that you had. Uh So again, we thank you for your time and thank you everyone for joining us. Published July 11, 2024 Created by Related Presenters Ian M. Cawich, MD Coronary InterventionsPeripheral Interventions View full profile
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