Intravascular ultrasound guided recanalization of stumpless chronic total occlusion.
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 The IVUS catheter was introduced into the side branch and it was withdrawn from the side branch to find the entry point of the occlusion, trying to engage another stiffer guide-wire on the occlusion point with the help of real-time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.
Park
Yongwhi
Y
Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
Park
Hun Sik
HS
Jang
Gui-Lyen
GL
Lee
Dong-Yeub
DY
Lee
Hyunsang
H
Lee
Ju Hwan
JH
Kang
Hyun Jae
HJ
Yang
Dong Heon
DH
Cho
Yongkeun
Y
Chae
Shung-Chull
SC
Jun
Jae-Eun
JE
Park
Wee-Hyun
WH
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*