Use of Intravascular Ultrasound in the Assessment of Chronic Total Occlusions

Abstract

Professor Werner's research interests focus on the interventional therapy of coronary artery disease, including intravascular ultrasound, chronic total occlusions (CTOs) and collateral physiology, and the applications of lasers in interventional cardiology. He is a pioneer of coronary imaging by ultrasound; his earliest publications in this field date back to 1991, and he was among the first to describe the phenomenon of intramural coronary haematoma, and subintimal vessel pathways during recanalisation of a chronic coronary occlusion. He received the Franz-Maximilian Groedel Award of the German Cardiac Society (GCS) for his work on collateral physiology in CTOs. He has published over 150 original papers and is Fellow of the European Society of Cardiology (ESC), American College of Cardiology (ACC) and the Society of Cardiovascular Angiography and Interventions (SCAI). He is also co-Founder and past-President of the EuroCTO club. Percutaneous intervention (PCI) for chronic total occlusion (CTO) is a complex procedure requiring specific training, which has been an obstacle to its widespread use. Intravascular ultrasound (IVUS) is a valuable technique for assessing the anatomy of complex coronary lesions. In this white paper, evidence supporting the use of IVUS in the assessment of CTOs is presented. In addition, the author introduces a workflow algorithm that can help support research and clinical decision making for different scenarios of IVUS use in the CTO setting.

Intravascular Ultrasound

“…IVUS is helpful in chronic total occlusions (CTO) management at multiple places. 14 • In ambiguous proximal occlusion cap-IVUS helps to determine the optimal entry point and evaluate guidewire penetration of the proximal cap of a CTO. • IVUS of the side branch at the occlusion site allows the cross-sectional image of the proximal cap and central lumen of the CTO.…”