IVUS-Guided Wiring Improves the Clinical Outcomes of Angioplasty for Long Femoropopliteal CTO Compared with the Conventional Intraluminal Approach

Abstract

This study aimed to assess the clinical efficacy of intravascular ultrasound (IVUS)-guided intraplaque wiring for femoropopliteal (FP) chronic total occlusion (CTO).Methods: This single-center, retrospective, observational study was performed at the Japanese Red Cross Kyoto Daini Hospital. From March 2013 to June 2017, a total of 75 consecutive patients (mean age: 75.4 8.5 years; 59 males), who underwent endovascular treatment (EVT), having 82 de novo FP-CTO lesions, were enrolled in this study. Eleven of the lesions that met the exclusion criteria were excluded, and the remaining 71 lesions were divided into the IVUS-guided wiring group (n 34) and non-IVUS-guided wiring group (n 37). Primary patency, defined as a peak systolic velocity ratio of 2.4 on duplex ultrasonography, and freedom from clinically driven target lesion revascularization (CD-TLR) at 12 months were the primary outcomes. Results:The mean lesion length was 21.6 8.9 cm. The frequencies of primary patency and freedom from CD-TLR were significantly higher in the IVUS-guided wiring group than in the non-IVUS-guided wiring group (70.0% vs. 52.2%, p 0.045; 83.9% vs. 62.8%, p 0.036, respectively). The complete clinically true lumen angioplasty rate was also higher in the IVUS-guided wiring group than in the non-IVUS-guided wiring group (91.1% vs. 51.3%, p 0.001, respectively). The clinically true and false wire passage rates were respectively 97.3% and 2.7% in the IVUS-guided wiring group. Conclusion: IVUS-guided wiring improves the clinical outcomes of EVT for FP-CTO by achieving a high clinically true lumen wire passage rate.CTO lesions compared with the subintimal approach 2-4) . Recently, Kawasaki et al. proposed that CTO wire passage routes should be classified into the intraplaque, subintimal, and intramedial routes based on intravascular ultrasound (IVUS) examinations (Fig. 1) 5) . They demonstrated that attempts to perform the wire loop technique with a 0.035 inch guidewire via the subintimal approach did not always result in the subintimal or intramedial route being taken. Conversely, Mori et al. reported that attempts to perform the drilling technique using a 0.014 inch guide-Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

Efficacy of navigating through the intraplaque route using AnteOwl WR intravascular ultrasound in femoropopliteal chronic total occlusion

“…There is no consensus on the optimal guidewire passage route for FP CTO lesions (Soga et al 2013;Mori et al 2017). However, some clinical studies have recently reported that IVUS-guided wiring improves the clinical outcomes of EVT for FP CTO (Mori et al 2017;Tsubakimoto et al 2020). The advantages of intraplaque guidewire crossing are as follows: a stent-less strategy can be realized using a drug-coated balloon even for CTO lesions, it can be expanded reliably and safely even when a stent is implanted, and the antegrade guidewire passage may reduce the need for an extra distal puncture for the retrograde approach.…”

“…Various techniques and devices have improved guidewire crossing and initial success for FP chronic total occlusion (CTO) (Kawasaki et al 2008;Urasawa et al 2014;Kitrou et al 2015;Tan et al 2017;Hayakawa et al 2020). Some studies have reported the usefulness of performing an intraluminal approach with intravascular ultrasound (IVUS) guidance (Mori et al 2017;Tsubakimoto et al 2020). Alternatively, IVUSguided intraplaque wiring requires high technical skills, and problems such as procedure time and the number of wires tend to be highlighted.…”

Efficacy of Navigating Through the Intraplaque Route using AnteOwl WR Intravascular Ultrasound in Femoropopliteal Chronic Total Occlusion

“…There is no consensus on the optimal guidewire passage route for FP CTO lesions (Soga et al, 2013, Mori et al, 2017. However, recently, some clinical studies have reported that IVUS-guided wiring improves the clinical outcomes of EVT for FP CTO (Mori et al, 2017;Tsubakimoto et al, 2020). The advantages of intraplaque guidewire crossing are as follows: a stent-less strategy can be realized using a DCB even for CTO lesions, it can be expanded reliably and safely even when a stent is implanted, and the antegrade guidewire passage may reduce the need for an extra distal puncture for the retrograde approach.…”

“…Various techniques and devices have improved guidewire crossing and initial success for FP chronic total occlusion (CTO) (Kawasaki et al, 2008;Urasawa et al, 2014;Kitrou et al, 2015;Tan et al, 2017;Hayakawa et al, 2020). Some studies have reported the usefulness of performing an intraluminal approach with intravascular ultrasound (IVUS) guidance (Mori et al, 2017;Tsubakimoto et al, 2020). Alternatively, IVUS-guided intraplaque wiring requires high technical skills, and problems such as procedure time and the number of wires tend to be highlighted.…”

Parallel Wiring Using a Single Intravascular Ultrasound Catheter with Double Rapid Exchange Lumens Technique for Chronic Total Occlusions in Peripheral Artery Disease

“…1,2 On the other hand, recent studies based on IVUS evaluation demonstrated that an intramedial CTO wire passage route was an independent predictor for restenosis after stenting. 3,4 IVUS-guided parallel wiring technique using an IVUS catheter with double rapid exchange lumens has been developed in PCI. 5,6 In general, a conventional IVUS-guided parallel wiring involves 2 separate systems: a first guidewire with an IVUS catheter and a second guidewire with a support catheter.…”