Intravascular ultrasound guided wiring for chronic total occlusions
Masahiko Ochiai1, Nobuhiko Ogata, Hiroshi Araki
1Division of Cardiology and Cardiovascular Surgery, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Kanagawa, Japan.
Abstract:
The success of percutaneous intervention for chronic total occlusion depends mainly on crossing the lesion with a wire. This report deals with the principles and the technical tips of intravascular ultrasound-guided wiring for chronic total occlusion, which can be divided into two trategies.The first is "identification of the site of entry." When the abrupt type chronic total occlusion with a side branch is treated, it is possible to identify the occlusion and the entry point by pulling back the intravascular ultrasound catheter from the distal part of the side branch.The second is "returning to the true lumen after entering a false lumen." If hematoma is caused by manipulating a wire in the false lumen that impairs visualization of the distal true lumen, an intravascular ultrasound catheter can be advanced into the false lumen.An attempt to make a successful re-entry into the true lumen can be achieved under intravascular ultrasound guidance.
