Parallel Wiring Using a Single Intravascular Ultrasound Catheter with Double Rapid Exchange Lumens Technique for
Michinao Tan1, Kazushi Urasawa1, Yusuke Sato1
1Cardiovascular Center, Tokeidai Memorial Hospital, Sapporo, Japan.
Insights
A novel parallel wiring technique using a single intravascular ultrasound (IVUS) catheter simplifies peripheral chronic total occlusions (CTOs) procedures. This method enhances guidewire crossing into the true lumen, improving treatment efficiency.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Peripheral chronic total occlusions (CTOs) present significant challenges in endovascular interventions.
- Accurate guidewire navigation is crucial for successful recanalization of CTOs.
- Intravascular ultrasound (IVUS) offers real-time visualization but requires precise guidewire manipulation.
Observation:
- A novel technique, PASSABLE (parallel wiring using a single intravascular ultrasound catheter with double rapid exchange lumens), was developed for peripheral CTOs.
- The technique was demonstrated in a patient with superficial femoral and popliteal artery CTOs.
- It involves using both lumens of a specialized IVUS catheter for parallel guidewire advancement within the lesion.
Findings:
- The PASSABLE technique successfully guided a second guidewire into the intraplaque region under IVUS visualization.
- The specialized catheter design and guidewire manipulation prevented premature exit from the entry port.
- Successful guidewire crossing into the distal true lumen was achieved, confirmed by IVUS.
Implications:
- The PASSABLE technique offers a potentially easier and more efficient method for IVUS-guided parallel wiring in peripheral CTOs.
- This approach may improve procedural success rates and reduce complications associated with CTO interventions.
- Further studies are warranted to validate the broader applicability and long-term outcomes of this technique.
Purpose:
To describe a parallel wiring using a single intravascular ultrasound catheter with double rapid exchange lumens (PASSABLE) technique for peripheral CTOs.
Technique:
The technique is demonstrated in a 73-year-old patient with CTOs of the superficial femoral and popliteal artery. Intravascular ultrasound (IVUS) examination revealed the first guidewire was advanced to the intramedial space of the popliteal artery. Following insertion of the first guidewire into only the distal rapid exchange lumen of the IVUS catheter and a second guidewire into the proximal rapid exchange lumen, a guidewire torquer was passed over it and tightened close to an exit port of the proximal rapid exchange lumen to prevent it from exiting an entry port while advancing the IVUS catheter. The IVUS catheter was advanced to the intraplaque region using only the distal rapid exchange lumen and the second guidewire was then advanced to the intraplaque region under IVUS guidance. The IVUS-guided wiring using the second guidewire on both the distal and proximal rapid exchange lumen was continued and resulted in a successful guidewire crossing into the distal true lumen.
Conclusion:
This novel technique may prove beneficial in enabling operators to perform IVUS-guided parallel wiring more easily and efficiently.
