Crossing Total Occlusions using a hydraulic pressure wave: a feasibility study

Crossing highly calcified occlusions is technically challenging mainly due to guidewire buckling. In an effort to prevent buckling, a catheter that uses a dynamic impulse load is proposed. The proposed Wave catheter consists of an input plunger to generate an impulse at the handle, a hydraulic pressure wave confined within a ∅2 mm catheter to transfer the impulse towards the tip, and an output plunger to transfer the impulse to the occlusion. To determine the feasibility of this catheter, an experiment was performed in which the input and output impulses were recorded as a function of the catheter type, curvature, and plunger travel distance. Additionally, the system was tested on artificial CTO models to determine the clinical validity. The catheter has illustrated the ability to safely transfer high-force impulses of up to 43 N (1.5 N required) with only minimum catheter type and no curvature dependency, allowing for delivering high-force impulses through tortuous vasculature and under any angle. Furthermore, the catheter was able to penetrate the artificial CTO models within 1 strike.