title: Intravascular ultrasound guided recanalization of stumpless chronic total occlusion.
abstract: BACKGROUND
  The recanalization success rate of blunt and vague stump (stumpless) CTO lesions, especially those with a side branch arising from the occlusion, has been significantly lower than that of tapered stump CTO lesions. Intravascular ultrasound (IVUS) may be useful to identify the occlusion point and may facilitate the passage of guide-wires. We evaluated the clinical feasibility of the IVUS-guided wiring technique for stumpless CTO lesions.
  
  
  METHODS
  Thirty-one consecutive patients (7 women; mean age: 61.0 ± 8.9 years) with 32 lesions were enrolled. The IVUS catheter was introduced into the side branch and it was withdrawn from the side branch to find the entry point of the occlusion, trying to engage another stiffer guide-wire on the occlusion point with the help of real-time IVUS imaging.
  
  
  RESULTS
  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 useful and safe for the recanalization of stumpless CTO lesions and might be a valuable tool for the recanalization of complex CTO lesions.
authors: Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
authors: Yongwhi
authors: Y
authors: Park
authors: Hun Sik
authors: HS
authors: Park
authors: Gui-Lyen
authors: GL
authors: Jang
authors: Dong-Yeub
authors: DY
authors: Lee
authors: Hyunsang
authors: H
authors: Lee
authors: Ju Hwan
authors: JH
authors: Lee
authors: Hyun Jae
authors: HJ
authors: Kang
authors: Dong Heon
authors: DH
authors: Yang
authors: Yongkeun
authors: Y
authors: Cho
authors: Shung-Chull
authors: SC
authors: Chae
authors: Jae-Eun
authors: JE
authors: Jun
authors: Wee-Hyun
authors: WH
authors: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*