A newly designed 0.018-in.-compatible inner dilator as a novel option for endovascular therapy with the crossover approach


This study aimed to investigate the efficacy of guiding sheath delivery with the crossover approach using a newly customized inner dilator for a 0.018-in. guidewire of the Destination® guiding sheath (Terumo Corporation, Tokyo, Japan) (18-system), compared with that of the conventional-type 0.035-in. guidewires with inner dilators (35-system), and to predict failure of guiding sheath delivery. We conducted a prospective multicenter case series study of the contralateral crossover approach using Destination®, to determine whether the 18-system could be a rescue system in cases in which the conventional 35-system failed. To evaluate the efficacy of the 18-system, we created an in vitro aortoiliac bifurcation model by using a silicone vessel. We enrolled 172 cases consecutively. The initial crossover approach with the 35-system failed in 37 cases (21.5%), and a second attempt with the 18-system was successful in all failed cases. The bifurcation angles in the 35-system failure cases were significantly steeper than those in the 35-system success cases. A receiver operating characteristic curve analysis demonstrated that an aortoiliac bifurcation angle of 68° was the optimal cut-off value for predicting failure of the crossover procedure. Data from the analysis using the silicone vessel model suggested that the 18-system provided superior results, especially in aortoiliac bifurcation angles steeper than 60°, consistent with the in vivo findings. The results of the initial use of the 18-system with the crossover approach suggest that it may be superior to the conventional 35-system, especially in cases of steeper aortoiliac bifurcation angles.

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We would like to thank Editage (www.editage.jp) for English language editing.


The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Correspondence to Kan Zen.

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Wakana, N., Zen, K., Kambayashi, D. et al. A newly designed 0.018-in.-compatible inner dilator as a novel option for endovascular therapy with the crossover approach. Cardiovasc Interv and Ther 35, 276–282 (2020). https://doi.org/10.1007/s12928-019-00620-x

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  • Endovascular therapy
  • Peripheral artery disease
  • Guiding sheath
  • Contralateral crossover approach