Intravascular Ultrasound Findings Associated With Hydrodynamic Contrast Recanalization (HDR) of Coronary Chronic
Salman A Arain1, Angelo Nascimbene1, Akshitha Yarrabothula1
1University of Texas, Houston, Texas, USA.
Insights
Hydrodynamic contrast recanalization (HDR) aids wire crossing in chronic total occlusion (CTO) percutaneous coronary interventions (PCI). IVUS imaging revealed intraplaque crossing in 91% and a unique "Starry Sky" sign, suggesting a safe mechanism.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Imaging
Background:
- Hydrodynamic contrast recanalization (HDR) is an emerging technique for chronic total occlusion (CTO) percutaneous coronary interventions (PCI).
- The precise mechanisms by which HDR facilitates wire crossing remain incompletely understood.
Purpose of the Study:
- To elucidate the impact of HDR on plaque characteristics and guidewire navigation during CTO PCI.
- To utilize intravascular ultrasound (IVUS) imaging to assess these effects.
Main Methods:
- Analysis of IVUS images from 35 patients who underwent successful HDR-guided CTO PCI.
- Assessment of guidewire position (intraplaque vs. extraplaque), plaque morphology, and vascular injury (intramural hematoma, dissection).
Main Results:
- Intraplaque guidewire crossing was achieved in 91% of cases post-HDR.
- A novel "Starry Sky" sign (intraplaque speckling) was observed in 68% of patients.
- Intramural hematoma occurred in 31%, with minor dissections in 4 cases; overall procedural success was 100% without major complications.
Conclusions:
- HDR appears to effectively facilitate intraplaque wire crossing in CTO PCI with minimal vessel injury.
- The "Starry Sky" sign on IVUS may indicate a key mechanism of HDR.
- Further research is warranted to validate these initial findings.
Background:
Hydrodynamic contrast recanalization (HDR) is a novel technique to facilitate wire crossing during chronic total occlusion (CTO) percutaneous coronary interventions (PCI). The mechanisms underlying HDR have not been fully described.
Aims:
To investigate the impact of HDR on plaque morphology and wire tracking during CTO PCI using intravascular ultrasound (IVUS) imaging.
Methods:
We identified 35 patients who underwent successful HDR and IVUS-guided CTO PCI at our institution between January 2023 and December 2024. We collected the following from IVUS images: wire position (intraplaque vs. extraplaque) within the CTO segment, plaque morphology, and evidence of vascular injury (intramural hematoma or dissection).
Results:
Immediate post-HDR IVUS images were available for analysis in all 35 patients. IVUS imaging revealed intraplaque guidewire crossing in 91% (n = 32) of cases. Intraplaque speckling, which we have termed the "Starry Sky" sign, was observed in 24 cases (68%), and intramural hematoma was found in 11 cases (31%). Four dissections were detected: two precluded direct distal wire re-entry necessitating the use of non-HDR techniques (94% technical success). The overall procedural success rate was 100%, and there were no PCI-related complications (perforation, myocardial infarction, or death).
Conclusions:
HDR is a novel CTO PCI technique that appears to facilitate intraplaque wire crossing without causing significant vessel injury. The presence of speckled plaque by IVUS is a unique feature of HDR that may suggest a mechanism underlying this technique. Additional studies are needed to confirm these findings.
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