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Intravascular Imaging in Chronic Total Occlusion Percutaneous Coronary Intervention
Ziad A Ali1, Rick H J A Volleberg2, Doosup Shin3
1Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, USA; New York Institute of Technology, Old Westbury, NY, USA.
Intravascular imaging (IVI) aids challenging percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). IVI helps guide wires and visualize complex lesion pathways, improving CTO-PCI success rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains technically demanding.
- Traditional angiography has limitations in visualizing complex CTO anatomy.
- Intravascular imaging (IVI) offers enhanced visualization beyond conventional angiography.
Purpose of the Study:
- To review the utility of intravascular imaging (IVI) in chronic total occlusion percutaneous coronary intervention (CTO-PCI).
- To highlight specific clinical scenarios where IVI is beneficial for CTO-PCI.
- To discuss current barriers and future directions for IVI adoption in CTO-PCI.
Main Methods:
- Review of current literature and clinical practices regarding IVI in CTO-PCI.
- Analysis of IVI's role in guidewire navigation and lesion assessment.
- Discussion of technical challenges and advancements in IVI technology for CTOs.
Main Results:
- IVI facilitates guidewire passage through ambiguous CTO caps.
- It aids in determining the intra- or extra-plaque guidewire trajectory.
- IVI assists in visualizing overlapping guidewires during complex retrograde CTO-PCI techniques.
Conclusions:
- Intravascular imaging significantly enhances the success and safety of CTO-PCI.
- Further technical advancements and wider adoption of IVI are needed to overcome CTO-PCI barriers.
- IVI provides critical insights for complex guidewire manipulation in CTO interventions.
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