Intravascular ultrasound‐guided wiring for chronic total occlusion

Furuichi, Shinichi; Airoldi, Flavio; Colombo, Antonio

doi:10.1002/ccd.21219

Cited by 27 publications

(19 citation statements)

References 71 publications

(94 reference statements)

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“…Previous studies have reported that IVUS is a valuable tool for recanalization of the chronic total occlusion (CTO) [29, 30] and IVUS-guided CTO intervention have been proved to be associated with lower 12-month major adverse cardiac event rate [31]. A recent meta-analysis of eight RCT have confirmed the IVUS-guided PCI could significantly reduce the risk of major adverse cardiac events and target lesion/vessel revascularization in patients with complex lesion, such as CTO and long coronary lesions[32].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: A meta-analysis

Ming

Zhang

et al. 2017

PLoS ONE

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This meta-analysis compared IVUS-guided with angiography-guided PCI to determine the effect of IVUS on the mortality in patients with LM CAD. Current guidelines recommend intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LM CAD; Class IIa, level of evidence B). A systematic search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases was conducted to identify randomized or non-randomized studies comparing IVUS-guided PCI with angiography-guided PCI in LM CAD. Ten studies (9 non-randomized and 1 randomized) with 6,480 patients were included. The primary outcome was mortality including all-cause death and cardiac death. Compared with angiography-guide PCI, IVUS-guided PCI was associated with significantly lower risks of all-cause death (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.47–0.75, p<0.001), cardiac death (RR 0.47, 95% CI 0.33–0.66, p<0.001), target lesion revascularization (RR 0.43, 95% CI 0.25–0.73, p = 0.002), and in-stent thrombosis (RR 0.28, 95% CI 0.12–0.67, p = 0.004). Subgroup analyses indicated the beneficial effect of IVUS-guide PCI was consistent across different types of studies (unadjusted non-randomized studies, propensity score-matched non-randomized studies, or randomized trial), study populations (Asian versus non-Asian), and lengths of follow-up (<3 years versus ≥3 years). IVUS-guided PCI in LM CAD significantly reduced the risks of all-cause death by ~40% compared with conventional angiography-guided PCI.PROSPERO registration number: CRD 42017055134.

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Section: Discussionmentioning

confidence: 99%

Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: A meta-analysis

Ming

Zhang

et al. 2017

PLoS ONE

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“…Three possible solutions have been proposed for the recanalization of stumpless CTO lesions: CT angiography, a retrograde approach via a collateral channel, and IVUS-guided wiring [8][9][10][19][20][21][22]. However, CT angiography cannot provide real-time information during PCI, and the retrograde approach requires specific guidewires and a rich supply of collaterals with diameters large enough to carry the guidewire and balloon.…”

Section: Discussionmentioning

confidence: 98%

“…The IVUS-guided wiring technique has two roles in PCI for CTO. First, the IVUS-guided wiring technique is useful in revealing the entry point of occlusion when the occlusion site is angiographically unrecognizable because of its smooth entrance into the adjacent side branch [8][9][10]. Second, the IVUS-guided wiring technique is also useful in repositioning a guidewire in the event of inadvertent sub-intimal passage [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…Although recently a few case reports have suggested that the intravascular ultrasound (IVUS)-guided wiring technique might be useful for the recanalization of stumpless CTO [8][9][10], its efficacy and safety have not been sufficiently elucidated, and therefore we assessed the technical feasibility of IVUS-guided recanalization of stumpless CTO lesions.…”

Section: Introductionmentioning

confidence: 99%

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Intravascular ultrasound guided recanalization of stumpless chronic total occlusion

Park

Jang

et al. 2011

International Journal of Cardiology

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“…As it was stated before, the main cause of CTO recanalisation failure is the inability to pass the guidewire to the distal true lumen. Modern CTO operators have improved these results by using IVUS guidance to achieve this target [23-25]. There are three main applications of IVUS guided recanalisation of CTO.…”

Section: Intravascular Ultrasound (Ivus)mentioning

confidence: 99%

The Role for Adjunctive Image in Pre-procedural Assessment and Peri-Procedural Management in Chronic Total Occlusion Recanalisation

Estévez‐Loureiro¹,

Ghione²,

Kılıçkesmez³

et al. 2014

CCR

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Non invasive coronary angiography with multislice computed tomography has exquisite sensitivity to detect calcium and even the faintest late contrast filling of the distal vessel. Calcium burden and occlusion length are still valuable markers of duration, complexity and success of the recanalisation procedure. The ability to visualise the vessel also in the occluded segment, especially if calcified, can also help the operator to understand where to pierce the proximal cap in stumpless occlusions and to predict unusual courses, especially in very tortuous arteries. Imaging side by side CT images and angiography during the recanalisation procedure is an established practice in many active CTO laboratories and algorithms for co-registration are designed to overcome the challenges of systo-diastolic and respiratory motion. Intravascular ultrasound is used in almost all cases by the experienced Japanese CTO operators but most of the times its main use is a better identification of the diseased segment after predilatation to ensure complete stent cover and appropriate stent expansion, an application similar to other complex non occlusive lesions. The specificity of IVUS during CTO recanalisation is the identification of the vessel path in stumpless occlusions and the guidance of wire reentry especially during reverse Controlled Retrograde Anterograde Tracking. Optical coherence tomography has limitations in the setting of CTO recanalisation because of the need of forceful contrast flushing to clear blood, contraindicated in the presence of anterograde dissections, and the limited penetration. The variability in the use of both non-invasive and invasive imaging during CTO recanalisation is immense, going from more than 90% in Japan to less than 20% in Europe and intermediate penetration in the USA. Probably the explanation is almost only in availability and cost because all countries see a progressive increase of use suggesting that these methods are becoming an established tool for guidance of CTO recanalisation.

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Intravascular ultrasound‐guided wiring for chronic total occlusion

Abstract: This report describes a wiring technique for a blunt chronic total occlusion with a side branch at the site of occlusion for which the operator has difficulty of awareness of the proper entry point angiographically.

Cited by 27 publications

References 71 publications

Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: A meta-analysis

Percutaneous coronary intervention in left main coronary artery disease with or without intravascular ultrasound: A meta-analysis

Intravascular ultrasound guided recanalization of stumpless chronic total occlusion

The Role for Adjunctive Image in Pre-procedural Assessment and Peri-Procedural Management in Chronic Total Occlusion Recanalisation

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