Figure - available from: Frontiers in Cardiovascular Medicine
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Applications of intravascular ultrasound for facilitating chronic total occlusion crossing. CART, controlled antegrade and retrograde tracking; CTO, chronic total occlusion; IVUS, intravascular ultrasound.
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Chronic total occlusions (CTOs) represent the most complex subset of coronary artery disease and therefore careful planning of CTO percutaneous coronary recanalization (PCI) strategy is of paramount importance aiming to achieve procedural success, and improve patient's safety and post CTO PCI outcomes. Intravascular imaging has an essential role in...
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Objective: Intravascular optical coherence tomography (IVOCT) is a useful tool to assess stent adherence and dilation, thus guiding percutaneous coronary intervention (PCI) and minimizing the risk of surgery. However, each pull-back OCT images may contain thousands of stent struts, which are tiny and dense, making manual stent labeling slow and cos...
Citations
... In addition, IVI can be used for identifying entry of CTO lesions, IVUS-guided puncture in case of angiographically ambiguous proximal cap, guidance in retrograde re-entry attempts, and confirmation of wire location (intraplaque vs. extraplaque tracking) after crossing [12]. Since OCT requires injection of contrast agents for image acquisition, which may extend dissection planes, IVUS is the preferred modality in the pre-PCI phase [13]. However, OCT can be useful to assess stent-related problems such as underexpansion, malapposition, or edge dissection and to optimize the stented segment(s). ...
... IVUS can also facilitate CTO lesion crossing in re-entry techniques (Fig. 2). With the emergence of advanced wire crossing techniques such as subintimal tracking and re-en-try (STAR) and reverse controlled antegrade and retrograde tracking (CART), IVUS can play a key role in these techniques [13]. In these crossing techniques, IVUS can confirm the position of the guide wire (intraplaque vs. extraplaque) and provide information about vessel size to determine the appropriate balloon size in reverse CART to increase successful wire crossing and reduce the risk of perforation [15]. ...
Although percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has been increasing in recent years, CTO PCI is still one of the most challenging procedures with relatively higher rates of procedural complications and adverse clinical events after PCI. Due to the innate limitations of invasive coronary angiography, intravascular imaging (IVI) has been used as an adjunctive tool to complement PCI, especially in complex coronary artery disease. Considering the complexity of CTO lesions, the role of IVI is particularly important in CTO intervention. IVI has been a useful adjunctive tool in every step of CTO PCI including assisted wire crossing, confirmation of wire location within CTO segment, and stent optimization. The meticulous use of IVI has been one of the greatest contributors to recent progress of CTO PCI. Nevertheless, studies evaluating the role of IVI during CTO PCI are limited. The current review provides a comprehensive overview of the mechanistic advantages of IVI in CTO PCI, summarizes previous studies and trials, and presents future perspective of IVI in CTO PCI.
The history of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) reflects the relentless pursuit of innovation in interventional cardiology. These intravascular imaging technologies have played a pivotal role in our understanding of coronary atherosclerosis, vascular pathology, and the interaction of coronary stents with the vessel wall. Two decades of clinical investigations demonstrating the clinical efficacy and safety of intravascular imaging modalities have established these technologies as staples in the contemporary cardiac catheterization lab’s toolbox and earning their place in revascularization clinical practice guidelines. In this comprehensive review, we will delve into the historical evolution, mechanisms, and technical aspects of IVUS and OCT. We will discuss the expanding evidence supporting their use in complex percutaneous coronary interventions, emphasizing their crucial roles in optimizing patient outcomes and ensuring procedural success. Furthermore, we will explore the substantial advances that have propelled these imaging modalities to the forefront of contemporary interventional cardiology. Finally, we will survey the latest developments in the field and explore the promising future directions that have the potential to further revolutionize coronary interventions.
