Intravascular ultrasound guided recanalization of stumpless chronic total occlusion

Park, Yongwhi; Park, Hun Sik; Jang, Gui-Lyen; Lee, Dong-Yeub; Lee, Hyunsang; Lee, Ju Hwan; Kang, Hyun Jae; Yang, Dong Heon; Cho, Yongkeun; Chae, Shung-Chull; Jun, Jae Bok; Park, Wee-Hyun

doi:10.1016/j.ijcard.2009.10.052

Cited by 53 publications

(37 citation statements)

References 26 publications

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“…To the best of our knowledge, this CTO-IVUS study is the first randomized trial investigating the clinical benefits of IVUS guidance for CTO intervention after successful guidewire 13,14 However, there are concerns on device-related complications and prolonged procedure times when using IVUS. In addition, there is little data on the relationship between successful CTO recanalization using IVUS guidance and clinical outcomes after stent implantation.…”

Section: Discussionmentioning

confidence: 98%

Clinical Impact of Intravascular Ultrasound–Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation

Kim

Shin

Hong

et al. 2015

Circ: Cardiovascular Interventions

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246

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P ercutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still challenging, and there are unmet needs even with the availability of drug-eluting stents (DESs). [1][2][3][4] Despite the development of novel techniques and technologies for CTO intervention, the increased clinical and angiographic risk factors accompanying more complex procedures have been associated with worse clinical outcomes. [3][4][5][6] The use of intravascular ultrasound (IVUS) has been recommended as 1 way to improve overall PCI clinical outcomes; however, few studies have evaluated its use during CTO intervention, and no randomized study has compared IVUS-guided CTO intervention with conventional angiography-guided intervention. 7-9Background-There have been no randomized studies comparing intravascular ultrasound (IVUS)-guided versus conventional angiography-guided chronic total occlusion (CTO) intervention using new-generation drug-eluting stent Therefore, we conducted a prospective, randomized, multicenter trial designed to test the hypothesis that IVUS-guided CTO intervention is superior to angiography-guided intervention. Methods and Results-After successful guidewire crossing, 402 patients with CTOs were randomized to the IVUS-guided group (n=201) or the angiography-guided group (n=201) and secondarily randomized to Resolute zotarolimus-eluting stents or Nobori biolimus-eluting stents. The primary and secondary end points were cardiac death and a major adverse cardiac event defined as the composite of cardiac death, myocardial infarction, or target-vessel revascularization, respectively. After 12-month follow-up, the rate of cardiac death was not significantly different between the IVUSguided group (0%) and the angiography-guided group (1.0%; P by log-rank test=0.16). However, major adverse cardiac event rates were significantly lower in the IVUS-guided group than that in the angiography-guided group (2.6% versus 7.1%; P=0.035; hazard ratio, 0.35; 95% confidence interval, 0.13-0.97). Occurrence of the composite of cardiac death or myocardial infarction was significantly lower in the IVUS-guided group (0%) than in the angiography-guided group (2.0%; P=0.045). The rates of target-vessel revascularization were not significantly different between the 2 groups. In the comparison between Resolute zotarolimus-eluting stent and Nobori biolimus-eluting stent, major adverse cardiac event rates were not significantly different (4.0% versus 5.7%; P=0.45). Conclusions-Although IVUS-guided CTO intervention did not significantly reduce cardiac mortality, this randomized study demonstrated that IVUS-guided CTO intervention might improve 12-month major adverse cardiac event rate after new-generation drug-eluting stent implantation when compared with conventional angiography-guided CTO intervention. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01563952. Kim et al Clinical Impact of IVUS-Guided CTO InterventionTherefore, we conducted a prospective, multicenter, randomized trial designed t...

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Section: Discussionmentioning

confidence: 98%

Clinical Impact of Intravascular Ultrasound–Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation

Kim

Shin

Hong

et al. 2015

Circ: Cardiovascular Interventions

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246

155

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“…When the side branch is located at the entrance of the CTO, the IVUS catheter can be inserted into the side branch to examine the place of wire penetration (15) (Fig. 7).…”

Section: Wire Techniques With Understanding Of Cto Histopathologymentioning

confidence: 99%

Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Sumitsuji

Inoue

Ochiai

et al. 2011

JACC: Cardiovascular Interventions

157

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Currently, successful treatment of chronic total occlusion (CTO) seems markedly improved, due to several new techniques and dedicated device developments. However, this improved success rate is often limited to procedures performed by skilled, highly experienced operators. To improve the overall success rate of percutaneous coronary intervention of CTO from a worldwide perspective, a deeper understanding of CTO histopathology might offer insights into the development of new techniques and procedural strategies. In this review, CTO histopathology and wire techniques are discussed on the basis of the fundamental concepts of antegrade and retrograde approaches. Although details pertaining to wire manipulation are very difficult to explain objectively, we tried to describe this as best as possible in this article. Finally, a systematic review of the current standard CTO strategy is provided. Hopefully, this article will enhance the understanding of this complex procedure and, consequently, promote safe and effective CTO-percutaneous coronary intervention for patients who present with this challenging lesion subset.

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“…Intravascular imaging can assist CTO crossing by (1) identifying the proximal cap in cases with proximal cap ambiguity (for example, by imaging through a side branch adjacent to the occlusion) 4 ; (2) confirming whether the antegrade guidewire Imaging for crossing: cases in which intravascular imaging was used for crossing the chronic total occlusion. No imaging or imaging for stent optimization: cases in which intravascular imaging was not used or cases in which intravascular imaging was used for stent optimization.…”

Section: Imaging For Cto Crossingmentioning

confidence: 99%

“…However, this technique has 2 potential limitations: first, IVUS cannot provide information on the course of the vessel distal to the occlusion (dual injection can be used to visualize the entire course of the vessel distal to the occlusion); second, IVUSguided wiring cannot be applied in cases without appropriate side branches (for example, with smaller vessel diameter than the IVUS catheters). 4 IVUS may be particularly useful for the retrograde approach to CTO crossing, as retrograde cases are often more complex than antegrade-only cases due to difficulties crossing the collateral and/or crossing the occlusion and Imaging for stent optimization: cases in which intravascular imaging was used for stent optimization. No imaging or imaging for crossing only: cases in which intravascular imaging was not used or cases in which intravascular imaging was used only for crossing the chronic total occlusion.…”

Section: Imaging For Cto Crossingmentioning

confidence: 99%

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Karácsonyi

Alaswad

Jaffer

et al. 2016

JAHA

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Intravascular ultrasound guided recanalization of stumpless chronic total occlusion

Cited by 53 publications

References 26 publications

Clinical Impact of Intravascular Ultrasound–Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation

Clinical Impact of Intravascular Ultrasound–Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation

Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

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