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IVUS Guidance

Abstract

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Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures Long-term survival in patients undergoing percutaneous interventions with or without intracoronary pressure wire guidance or intracoronary ultrasonographic imaging: a large cohort study Novel predictor of target vessel revascularization after coronary stent implantation: Intraluminal intensity of blood speckle on intravascular ultrasound Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis
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Clinical Case StudyJune 2017, Volume 33, Issue 6, pp 807–813

JOURNAL：Int J Cardiovasc Imaging. Article Link

Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results

Ryan N1, Gonzalo N, Escaned J et al. Keywords: Chronic total occlusion; Intravascular ultrasound; Percutaneous coronary intervention

ABSTRACT

Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneousrevascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution. CTO operators with extensive IVUS experience in non-CTO cases carried out all procedures. Procedural and outcome data was prospectively entered into the institutional database and a retrospective analysis of clinical, angiographic and technical data performed. 17 (77%) of the 22 procedures were successful. The mean age was 59.8 ± 11.5 years, and 90.9% were male. The most commonly attempted lesions were located in the left anterior descending 36.4% (Soon et al. in J Intervent Cardiol 20(5):359-366, 2007) and Circumflex artery (LCx) 31.8% (Mollet et al. in Am J Cardiol 95(2):240-243, 2005). Mean JCTO score was 3.09 ± 0.75 (3.06 ± 0.68, 3.17 ± 0.98 in the successful and failed groups respectively p = 0.35). The mean contrast volume was 378.7 ml ± 114.7 (389.9 ml ± 130.5, 349.2 ml ± 52.2 p = 0.3 in the successful and failed groups respectively). There was no death, coronary artery bypass grafting or myocardial infarction requiring intervention in this series. When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO-PCI success. This series describes a good success rate in IVUS guided stumpless wiring of CTOs in consecutive patients with this complex anatomical scenario.
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