A Simple Approach for 3D IVUS-Angiographic Co-Registration for CTOs Using the "Be-The-Wire" Cognitive Model

Area of Science:

• Cardiovascular Interventions
• Medical Imaging
• Interventional Cardiology

Background:

• Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) demands precise guidewire navigation.
• Intravascular ultrasound (IVUS) offers anatomical detail but faces challenges in 3D image co-registration with angiography.
• Co-registration failures can lead to procedural failure in complex CTO PCI.

Purpose of the Study:

• To introduce and explain the "Be-The-Wire" cognitive model for intuitive 3D IVUS-angiographic co-registration.
• To provide a simple, mnemonic-based method to enhance guidewire control during CTO PCI.
• To improve the safety and success rates of complex CTO PCI procedures.

Main Methods:

• The "Be-The-Wire" model involves adopting the perspective of the IVUS wire.
• Key steps include optimizing angiographic views, deducing C-arm angles, and aligning IVUS display to the vessel trajectory.
• This technique facilitates intuitive 3D IVUS-angiographic co-registration without complex software.

Main Results:

• The "Be-The-Wire" model offers a straightforward approach to 3D IVUS-angiographic co-registration.
• It enhances operator understanding and control of guidewire navigation in CTO PCI.
• The method aims to improve procedural efficiency and outcomes.

Conclusions:

• The "Be-The-Wire" cognitive model is a valuable tool for interventional cardiologists performing CTO PCI.
• It simplifies the complex task of 3D IVUS-angiographic co-registration, enhancing guidewire control.
• Mastering this technique can contribute to improved safety and success in challenging PCI procedures.