HD-IVUS-Guided Tip Detection-Antegrade Dissection and Re-Entry (TD-ADR): First Experience in North America
Brian Heng Li1, Navneet Sharma2, Jaikirshan Khatri3
1Division of Cardiology, Department of Medicine, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada.
JACC. Case Reports
|March 7, 2025
Summary
This case study demonstrates a novel technique for treating complex chronic total occlusions using high-definition intravascular ultrasound (HD-IVUS) to guide dissection and re-entry. This imaging-guided approach offers a new strategy for challenging percutaneous coronary interventions.
Area of Science:
- Cardiovascular Interventions
- Medical Imaging
- Interventional Cardiology
Background:
- Chronic total occlusions (CTO) pose significant challenges in percutaneous coronary intervention (PCI).
- Antegrade dissection and re-entry (ADR) is an advanced technique for CTO PCI.
- High-definition intravascular ultrasound (HD-IVUS) offers enhanced visualization for complex PCI procedures.
Observation:
- A novel HD-IVUS-guided tip detection-ADR technique was successfully applied.
- This procedure utilized commercially available equipment, marking a first in North America.
- Previous attempts using conventional methods were unsuccessful.
Findings:
- The HD-IVUS-guided ADR technique enabled successful re-entry in a challenging CTO case.
- The use of off-the-shelf equipment demonstrates the adaptability of the technique.
- This approach facilitated a complex percutaneous coronary intervention.
Implications:
- Imaging-guided ADR can be a valuable adjunctive strategy for difficult CTO PCI.
- This technique expands the armamentarium for interventional cardiologists treating CTOs.
- Successful replication with standard equipment broadens the accessibility of this advanced technique.
Keywords:
cardiovascular diseasecoronary circulationimagingintravascular ultrasoundpercutaneous coronary interventionultrasound
