IVUS / Park Y

Intravascular ultrasound guided recanalization of stumpless chronic total occlusion.

Park Y, Park HS, Jang GL, Lee DY, Lee H, Lee JH, Kang HJ, Yang DH, Cho Y, Chae SC, Jun JE, Park WH.

Int J Cardiol. 2009 Nov 24

OBJECTIVES:

Evaluation of the IVUS-guided wiring technique for stumpless CTO lesions as intravascular ultrasound (IVUS) may be useful to identify the occlusion point and facilitate the passage of guide-wires.

METHODS:

• 31 patients
• All stumpless CTO lesions with a side branch arising from the occlusion which was suitable for IVUS study
• The IVUS catheter was first introduced into the side branch
• It was then withdrawn from the side branch to find the entry point of the occlusion
• With the help of real-time IVUS imaging, it was tryed to engage another stiffer guide-wire on the occlusion point

SUMMARY:

• The left anterior descending artery was the most common target-lesion location (22 lesions / 69 %).
• CTO lesions were successfully reopened in 26 lesions (81 %).
• IVUS guidance allowed confident navigation of the stiff guide-wires.
• The entry point could not be identified in one, and full guide-wire passage was impossible in 4 with the IVUS guidance.
• TIMI 3 flow could not be achieved even after stent deployment in 1.
• Although procedure-related complications developed in 8 lesions (25 %), no events were serious.
• Emergent operation was not needed and death or fatal myocardial infarction did not develop during or after the procedures.

CONCLUSIONS:

The IVUS-guided wiring technique is technically feasible and safe for the recanalization of stumpless CTO lesions. Combining other imaging modalities with the guidewire crossing technique might facilitate the successful recanalization of complex CTO lesions.

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