Transvenous Intravascular Ultrasound–Guided Endovascular Treatment for Chronic Total Occlusion of the Infrainguinal Arteries

Takahashi, Yasuhiro; Sato, Taisuke; Okazaki, Hirotake; Nozaki, Ayaka; Matsushita, M.; Kamiya, Masataka; Shimizu, Wataru

doi:10.1177/1526602817723139

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…Guidewire: As recommended by the authors [6], [23], [32] a stiff 0.035-inch guidewire is the right choice, especially for crossing the lower extremity arteries. Although we chose a stiff 0.035-inch TERUMO guidewire (Terumo Corporation, Tokyo, Japan) with Radifocus J-tip, our experiments used its stiff end as a straight-tipped guidewire to simplify the modelling efforts and experimental validation.…”

Section: Methodsmentioning

confidence: 99%

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Modeling and Prediction of a Guidewire's Reachable Workspace and Deliverable Forces

Aghdam

Tavallaei

2022

IEEE Open J. Eng. Med. Biol.

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In this study, we investigated the feasibility of predicting the performance of a specific guidewire in terms of its ability to cover a lesion cap surface and apply force to the lesion for a given patient's vessel anatomy. The aim of this research was to provide information that could be used to plan occlusion crossings and peripheral revascularization procedures preoperatively in a way that reduces the risk of potential intraoperative complications and increases the likelihood of success. Methods: We used finite element (FE) analysis to simulate the interaction between the guidewire and a model of a tortuous vessel, and we used this simulation to predict the reachable workspace and deliverable forces of the device for various entry positions and angles. We then validated these predictions through experiments in which we advanced a guidewire through an identical vessel phantom using a robotic manipulator. Conclusions: Our findings suggest that it may be possible to predict the performance of a guidewire and forecast the likelihood of success or failure for a given vessel anatomy and lesion morphology, which could enable improved planning and device selection.

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Section: Methodsmentioning

confidence: 99%

“…Introducer Sheath: A cylindrical rigid shell model with a diameter of 2 mm and shell thickness of 0.5 mm with quadrilateral elements is used to mimic a 6-Fr introducer [23]. The guidewire is assumed to be concentric to the sheath.…”

Section: Table I Materials Properties Of the Different Components Use...mentioning

confidence: 99%

Modeling and Prediction of a Guidewire's Reachable Workspace and Deliverable Forces

Aghdam

Tavallaei

2022

IEEE Open J. Eng. Med. Biol.

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“…Takahashi et al 11 used a transvenous IVUS technique for CTO recanalization utilizing a 10-MHz IVUS catheter, which allowed good visualization of guidewire penetration and navigation, even in cases with severe vessel calcification. It is worth noting that the rate of stenting was extremely low in this experience, suggesting that transvenous IVUS-guided CTO crossing may help the operator maintain the intraplaque pattern, rather than shifting it into the subintimal plane.…”

Section: Common Cto Crossing Techniques and Devicesmentioning

confidence: 99%

“…In the October 2017 issue of the JEVT , Takahashi and coauthors 11 investigated the 1-year outcome of a novel approach for CTO recanalization, that is, transvenous intravascular ultrasound (IVUS)–guided endovascular therapy (EVT) for the treatment of femoropopliteal or tibioperoneal trunk CTOs. In this study, IVUS-guided EVT was performed in 44 patients (50 limbs), with successful recanalization (defined as grade 3 TIMI flow and no flow-limiting dissection) observed in 48 (96%) limbs, including 23 (92%) of 25 patients with moderate or severe calcification.…”

Section: Introductionmentioning

confidence: 99%

Commentary: IVUS-Guided Recanalization of Peripheral CTOs: No More Eyes Wide Shut for Physicians?

et al. 2017

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“…e adjunctive use of IVUS during endovascular treatment of PAD seems to positively a ect intraprocedural, short-and midterm outcomes and can help to minimize intimal and medial damage during CTO crossing. [54][55][56][57]65,66 In selected patients with severe chronic kidney disease or contrast allergy, IVUS can form a viable alternative to angiography for diagnosis and treatment veri cation. [62][63][64]67,68 Integration of IVUS in re-entry devices can aid subintimal revascularization of guidewire-resistant CTOs and lead to improved technical success and reduced complications by supporting true lumen re-entry.…”

Section: Ivus-integrated Devicesmentioning

confidence: 99%

Intraoperative imaging, navigation and radiation management in aortic and peripheral endovascular procedures

Jansen

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Endovascular techniques are essential in treating vascular conditions, to ensure safe and rapid recovery, particularly for elderly and vulnerable patients. Approximately 60% of vascular treatments currently employ endovascular techniques. Within the expanding field of endovascular techniques, there is a growing demand for advanced imaging technology. The current reliance on fluoroscopy has limitations, including exposure to radiation and limited 3D interpretation. This dissertation primarily focuses on reducing radiation exposure and optimizing intraoperative imaging and navigation, with an emphasis on introducing Fiber Optic RealShape (FORS) technology developed by Philips Medical. FORS enables real-time 3D visualization of guidewires and catheters while minimizing radiation use. This innovation promises significant progress in the quality of endovascular treatments. The dissertation also explores other methods to decrease radiation exposure, such as using radiation-absorbing cloths, and provides guidelines for optimizing the operating room setup. Additionally, it offers a comprehensive overview of current imaging and navigation in peripheral endovascular procedures, delving into image fusion—a technique combining conventional real-time fluoroscopy with 3D imaging data. The study focuses on artery displacement during operations and the challenges it poses to guidance accuracy. The dissertation underscores the critical importance of advanced imaging technologies for advancing endovascular techniques and provides practical solutions to overcome current limitations, significantly enhancing the quality of endovascular treatments.

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Transvenous Intravascular Ultrasound–Guided Endovascular Treatment for Chronic Total Occlusion of the Infrainguinal Arteries

Abstract: Transvenous IVUS-guided EVT is safe and can provide optimal short-term results for EVT of CTO in the infrainguinal arteries. IVUS-guided EVT may be one of the most effective treatment strategies for CTO of the femoropopliteal arteries or tibioperoneal trunk.

Cited by 9 publications

References 20 publications

Modeling and Prediction of a Guidewire's Reachable Workspace and Deliverable Forces

Modeling and Prediction of a Guidewire's Reachable Workspace and Deliverable Forces

Commentary: IVUS-Guided Recanalization of Peripheral CTOs: No More Eyes Wide Shut for Physicians?

Intraoperative imaging, navigation and radiation management in aortic and peripheral endovascular procedures

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