title: Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results.
abstract: Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (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.
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0002-2451-8790
authors.initials: N
authors.lastname: Ryan
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Philip
authors.initials: P
authors.lastname: Dingli
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Oscar Vedia
authors.initials: OV
authors.lastname: Cruz
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Nuñez-Gil
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: María Del
authors.initials: MD
authors.lastname: Trigo
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Salinas
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernandez-Ortiz
authors.affiliation: Hospital Clínico San Carlos and Universidad Complutense de Madrid, Madrid, Spain. escaned@secardiologia.es.|Cardiovascular Institute, Hospital Clínico San Carlos, Calle Prof Martin Lagos, 28040, Madrid, Spain. escaned@secardiologia.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Chronic total occlusion; Intravascular ultrasound; Percutaneous coronary intervention