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The Slipstream and Tip-Detection Technique: A Simplified AnteOwl-IVUS-Guided Re-Entry Strategy for Complex
Masataka Yoshinaga1, Akane Miyazaki1, Takashi Muramatsu2
1Department of Cardiology, Fujita Health University Bantane Hospital, Aichi, Japan.
Insights
This study presents a novel technique using intravascular ultrasound (IVUS) for complex chronic total occlusions (CTOs) in leg arteries. The AnteOwl WR IVUS-guided slipstream and tip-detection method offers a bailout strategy for challenging cases.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Medical Imaging
Background:
- Long lower-extremity chronic total occlusions (CTOs) pose significant challenges for endovascular intervention.
- Controlled true-lumen crossing is often difficult, especially when subintimal pathways are encountered or initial guidewire access fails.
Abstract:
Long lower-extremity chronic total occlusions (CTOs) often require subintimal passage, and controlled true-lumen crossing can be challenging, particularly when (1) the distal true lumen is reached, but part of the CTO is subintimal or (2) the first wire stalls subintimally without distal access. We report 2 patients with common iliac or superficial femoral artery CTOs treated with AnteOwl WR intravascular ultrasound (AO-IVUS)-guided slipstream and tip-detection. AO-IVUS was advanced over the first wire using the first-wire lumen only, and a dual-lumen microcatheter was tracked along the same wire (slipstream). Under IVUS tip-detection, a second guidewire was redirected into an all-true-lumen or functionally intraluminal course, enabling definitive stent or drug-coated balloon therapy without distal puncture or dedicated re-entry devices. AO-IVUS-guided slipstream and tip-detection may be a practical bailout strategy for complex aortoiliac and femoropopliteal CTOs.
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