scholarly journals Efficacy of Navigating Through the Intraplaque Route using AnteOwl WR Intravascular Ultrasound in Femoropopliteal Chronic Total Occlusion

2021 ◽  
Author(s):  
Naoki Hayakawa ◽  
Satoshi Kodera ◽  
Keisuke Takanashi ◽  
Shuichi Sahashi ◽  
Sandeep Shakya ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Chronic Total Occlusion ◽  
Stent Deployment ◽  
Total Occlusion ◽  
Left Lower Limb ◽  
The Right ◽  
High Possibility ◽  
Good Expansion ◽  
Drug Coated Balloon ◽  
Control Angiography

Abstract BackgroundThere 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 (DCB) 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 presentationCase 1 was a 79-year-old man undergoing hemodialysis who presented with claudication of the left lower limb. Control angiography showed total occlusion of the left superficial femoral artery (SFA). We performed antegrade wiring, but the guidewire was advanced into the subintimal space. We advanced AnteOwl into CTO. Using the AnteOwl IVUS transducer and IVUS-wire bias, we found that the IVUS-wire is at the top and the transducer is at the bottom, and based on this information, a plaque to aim exists on the right side of the IVUS catheter at right anterior oblique of 30°. 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 DCB. Case 2 was of an 76-year-old woman with ulceration and gangrene of the left foot. Control angiography showed total occlusion from the SFA to the popliteal artery (Pop A). When AnteOwl was placed on the wire and advanced to the Pop A, the subintimal space in the middle of the SFA could be visualized. We employed an IVUS-guided parallel wire 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.ConclusionsAnteOwl is an effective IVUS technique for FP CTO and facilitates a complex IVUS-guided procedure.

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

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.

scholarly journals A novel real-time intravascular ultrasound double-lumen microcatheter for recanalization of chronic total occlusion: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Yanzhuo Ma ◽  
Yuhong Peng ◽  
Gang Wang ◽  
Leisheng Ru
Keyword(s):  
Coronary Artery ◽  
Real Time ◽  
Intravascular Ultrasound ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
True Lumen ◽  
Double Lumen ◽  
Total Occlusion ◽  
New Device ◽  
The Right

Abstract Background Chronic total occlusion revascularization remains a challenging problem because of its complexity. We present a case of a patient with chronic total occlusion who was successfully revascularized with the use of a new device called a real-time intravascular ultrasound double-lumen microcatheter. Case presentation A 58-year-old East Asians woman presented to our hospital with a complaint of recurrent chest pain of 5 months’ duration. Angiography revealed chronic total occlusion of the right coronary artery from the right coronary artery ostium to the ostia of the posterolateral and posterior descending branches. A guidewire was passed to the distal right coronary artery but went into the false lumens at the posterior descending and posterolateral ostia after use of the antegrade and retrograde approaches. Hence, we used the new device to pass through the subintimal right coronary artery space with reentry into the true lumen before the posterior descending and posterolateral ostia. A stent was successfully deployed at the posterior descending and posterolateral ostia, and the final result was excellent. Conclusions This device was useful for finding the entry point and for reentry into the true lumen of a chronic total occlusion. It may be a valuable tool for recanalization of complex chronic total occlusion lesions.

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

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.

scholarly journals Coil Embolization of Coronary-Cameral Fistula Complicating Revascularization of Chronic Total Occlusion

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Amy Mertens ◽  
Pratik Dalal ◽  
Michael Ashbrook ◽  
Ivan Hanson
Keyword(s):  
Coronary Artery ◽  
Right Ventricle ◽  
Coil Embolization ◽  
Chronic Total Occlusion ◽  
Potential Complication ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Coronary Cameral Fistula ◽  
The Right

Traumatic vessel perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). A rare consequence of this complication is a coronary-cameral fistula. The management of this condition is not well elucidated. Herein, we present such a case of symptomatic left anterior descending to the right ventricle (LAD-RV) fistula which was treated with coil embolization.

Convenience of Intravascular Ultrasound in Coronary Chronic Total Occlusion Recanalization

2020 ◽  
pp. 25-53
Author(s):  
Juan Rigla ◽  
Josep Rigla ◽  
Fernando Ramos ◽  
Josep Lluís Gómez-Huertas ◽  
Lukasz Partyka ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Chronic Total Occlusion ◽  
Total Occlusion
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