Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results

Abstract

Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution. CTO operators with extensive IVUS experience in non-CTO cases carried out all procedures. Procedural and outcome data was prospectively entered into the institutional database and a retrospective analysis of clinical, angiographic and technical data performed. 17 (77%) of the 22 procedures were successful. The mean age was 59.8 ± 11.5 years, and 90.9% were male. The most commonly attempted lesions were located in the left anterior descending 36.4% (Soon et al. in J Intervent Cardiol 20(5):359-366, 2007) and Circumflex artery (LCx) 31.8% (Mollet et al. in Am J Cardiol 95(2):240-243, 2005). Mean JCTO score was 3.09 ± 0.75 (3.06 ± 0.68, 3.17 ± 0.98 in the successful and failed groups respectively p = 0.35). The mean contrast volume was 378.7 ml ± 114.7 (389.9 ml ± 130.5, 349.2 ml ± 52.2 p = 0.3 in the successful and failed groups respectively). There was no death, coronary artery bypass grafting or myocardial infarction requiring intervention in this series. When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO-PCI success. This series describes a good success rate in IVUS guided stumpless wiring of CTOs in consecutive patients with this complex anatomical scenario.

Intravascular ultrasound in percutanous coronary intervention for chronic total occlusions: predictors of use, indications and in-hospital outcome

“…In a series involving 22 patients who underwent CTO-PCI using IVUS guidance for stumpless ostial CTO, successful outcome was achieved in 17 cases (77.3%), while no complications related with the use of IVUS were noticed [15]. Interestingly, When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO PCI success.…”

A novel real-time intravascular ultrasound double-lumen microcatheter for recanalization of chronic total occlusion: a case report

“…It has been demonstrated that IVUS-guided CTO intervention improved clinical outcomes and might reduce the rate of 12-month major adverse cardiac events when compared with angiography-guided CTO intervention [12, 13]. IVUS images provide information about lesion morphology and contribute to successful procedural results in CTO lesions [12, 14, 15], such as by helping to resolve the ambiguity of the proximal cap [16], facilitating reentry into the true lumen after subintimal crossing [17–19], and helping to find the entry point of the stump [20, 21]. Two catheter types have been used in clinical practice: rotating transducer catheters and electronic array catheters.…”

Intracoronary Imaging: Current Practice and Future Perspectives

“…The most frequent cause of failure in CTO recanalization is inability of the guide wire to cross the lesion [58]. In a single center series of IVUS-guided stumpless wiring of CTOs, Ryan et al [58] reported a success rate of 77% of cases and no major complications requiring intervention. IVUS has been proposed as a safe and effective tool in guiding the reverse CART approach.…”