Transvenous Intravascular Ultrasound–Guided Endovascular Treatment for Chronic Total Occlusion of the Infrainguinal Arteries

Purpose: To investigate the 1-year outcomes of transvenous intravascular ultrasound (IVUS)–guided endovascular therapy (EVT) for chronic total occlusion (CTO) of the lower extremity arteries. Methods: Transvenous IVUS-guided EVT was performed in 44 patients (50 limbs) with CTO of the femoropopliteal arteries or tibioperoneal trunk. Treatment involved crossing a guidewire through the CTO under the guidance of both fluoroscopic and IVUS imaging, along with insertion of the IVUS catheter into a vein parallel to the target artery. Primary success rate, complications, and target lesion revascularization (TLR) at 12-month follow-up were investigated. Results: Successful recanalization, defined as grade 3 flow (Thrombolysis in Myocardial Infarction score) and no flow-limiting dissection, was observed in 48 (96%) limbs. Two limbs with failed recanalization had a very long CTO lesion from the superficial femoral artery to below the knee. A bidirectional approach was selected in 11 (22%) limbs. Complications at the access site occurred in only 2 patients. The rate of freedom from TLR at 12 months was 77.9% (95% confidence interval 61.4 to 87.9). Conclusion: Transvenous IVUS-guided EVT is safe and can provide optimal short-term results for EVT of CTO in the infrainguinal arteries. IVUS-guided EVT may be one of the most effective treatment strategies for CTO of the femoropopliteal arteries or tibioperoneal trunk.

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TCTAP C-182 Intravascular Ultrasound Guided Coronary Intervention in Chronic Total Occlusion with Long Term Follow Up with Positive Vessel Remodeling

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.03.414 ◽

2017 ◽

Vol 69 (16) ◽

pp. S269-S270

Author(s):

Debdatta Bhattacharyya ◽

Debabrata Bera ◽

Ayan Kar

Keyword(s):

Intravascular Ultrasound ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Ultrasound Guided ◽

Total Occlusion ◽

Vessel Remodeling ◽

Long Term Follow Up

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Intravascular Ultrasound–Guided True Lumen Reentry Device for Recanalization of Unilateral Chronic Total Occlusion of Iliac Arteries: Technique and Follow-Up

Annals of Vascular Surgery ◽

10.1016/j.avsg.2009.12.002 ◽

2010 ◽

Vol 24 (4) ◽

pp. 487-497 ◽

Cited By ~ 19

Author(s):

Venkataramu N. Krishnamurthy ◽

Jonathan L. Eliason ◽

Peter K. Henke ◽

John E. Rectenwald

Keyword(s):

Intravascular Ultrasound ◽

Chronic Total Occlusion ◽

Ultrasound Guided ◽

True Lumen ◽

Total Occlusion ◽

Iliac Arteries

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Efficacy of navigating through the intraplaque route using AnteOwl WR intravascular ultrasound in femoropopliteal chronic total occlusion

CVIR Endovascular ◽

10.1186/s42155-021-00228-4 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Naoki Hayakawa ◽

Satoshi Kodera ◽

Keisuke Takanashi ◽

Shuichi Sahashi ◽

Sandeep Shakya ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Popliteal Artery ◽

Chronic Total Occlusion ◽

Asymmetric Structure ◽

Stent Deployment ◽

Total Occlusion ◽

Antegrade Approach ◽

Angiographic Image ◽

Good Expansion ◽

Drug Coated Balloon

Abstract Background There is no consensus on the optimal guidewire passage route for femoropopliteal (FP) chronic total occlusion (CTO). If intraplaque wiring can be performed, a stent-less strategy using a drug-coated balloon can be realized even with FP CTO, and there is a high possibility that good expansion can be obtained even when stent deployment is performed. AnteOwl WR (AnteOwl) is a novel intravascular ultrasound (IVUS) device useful for navigating the second guidewire into the intraplaque route under IVUS observation from the subintimal space. Here, we describe representative cases of FP CTO in which CTO-specific IVUS was extremely useful. Case presentation Case 1 involved a 79-year-old man with total occlusion of the left superficial femoral artery (SFA). We used a contralateral antegrade approach, but the guidewire was advanced into the subintimal space. We advanced AnteOwl into the CTO. By utilizing the asymmetric structure of the transducer and the IVUS wire, we were able to reflect the positional relationship among the IVUS transducer, IVUS wire, and target plaque onto the angiographic image. By aiming the wiring in that direction, we succeeded in traversing the center of the plaque and finally succeeded in obtaining good expansion using the drug-coated balloon. Case 2 involved a 76-year-old woman with total occlusion from the SFA to the popliteal artery. We used an ipsilateral antegrade approach. When AnteOwl was placed on the wire and advanced to the popliteal artery, the subintimal space in the middle of the SFA could be visualized. We employed an IVUS-guided parallel wiring technique and succeeded in passing through all intraplaque routes. Although the CTO was long, we could easily advance through the intraplaque route by reflecting the information obtained from AnteOwl in angiography. Conclusions AnteOwl is an effective IVUS for FP CTO and facilitates a complex IVUS-guided procedure.

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Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging

The Egyptian Heart Journal ◽

10.1186/s43044-020-00104-x ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Mohammad Abdallah Eltahlawi ◽

Abdel-Aziz Fouad Abdel-Aziz ◽

Abdel-Salam Sherif ◽

Khalid Abdel-Azeem Shokry ◽

Islam Elsayed Shehata

Keyword(s):

Chronic Total Occlusion ◽

Bioresorbable Vascular Scaffold ◽

Total Occlusion ◽

Intracoronary Imaging ◽

Group I ◽

Significant Difference ◽

Vascular Scaffold ◽

Long Term Follow Up

Abstract Background We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. Results At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. Conclusion This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. Trial registration ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: [email protected]

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P3587Tip detection method using the new short-tip IVUS with pull-back system which facilitates the 3D wiring technique in percutaneous coronary intervention for chronic total occlusion

European Heart Journal ◽

10.1093/eurheartj/ehz745.0447 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Tanaka ◽

A Okamura ◽

M Iwakura ◽

H Nagai ◽

A Sumiyoshi ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Intravascular Ultrasound ◽

Chronic Total Occlusion ◽

Distal Part ◽

Detection Method ◽

Coronary Intervention ◽

Procedure Time ◽

True Lumen ◽

Total Occlusion ◽

Percutaneous Coronary

Abstract Background The strategy of intravascular ultrasound (IVUS)-guided wiring for CTO PCI, that is, leading the second guidewire into the true lumen under observing by IVUS from subintimal space, is the last resort. We developed the angiography-based 3D wiring method. During establishment of the angiography-based 3D wiring method, we deduced that observation of the guidewire tip as well as the shaft named “The tip detection method” simplifies and facilitates 3D wiring under IVUS-guided wiring. Therefore, we produced New CTO IVUS which is the upgraded version of Navifocus WR IVUS by adding the pull-back transducer system. This pull-back system enables us to detect the tip as well as the shaft of the second guidewire in real time (tip detection method), which facilitates the 3D wiring technique under IVUS-guided wiring. Objective We evaluated the efficacy of the tip detection method during 3D wiring for CTO PCI with New CTO IVUS. Method We created a target pinpoint penetration model and performed the procedures using an experimental heartbeat model. The target (a tube with a lumen 0.6 mm in diameter) was placed in the distal part of a CTO 20 mm in length made of 2.5% agar. After the second guidewire (Conquest-12g) was advanced into the CTO lesion to within 5mm of the target using the angiography-based wiring, IVUS-guided wiring was performed by using Navifocus WR or New CTO IVUS each five times. Result The frequency of the puncture time was reduced using the new CTO IVUS compared to the Navifocus WR (1.7±0.8 vs. 28.8±23.2, p=0.17). The procedure time was significantly shorter using the new CTO IVUS compared to the Navifocus WR (103±61 vs. 459±373 seconds, p=0.04). Conclusion The tip detection method during 3D wiring with the new short tip IVUS with the pull-back system enables us to easily perform 3D wiring and will change the CTO PCI strategy.

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