Intravascular Ultrasound-Guided "Move the Cap" Technique for Heavily Calcified Ostial Chronic Total Occlusion
Kiwamu Sudo1, Masakazu Yasuda1, Kota Tanaka1
1Cardiovascular Center, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan.
Background:
The "move the cap" technique is used to overcome ambiguous or impenetrable proximal caps in chronic total occlusion (CTO).
Case Summary:
We describe a case where intravascular ultrasound (IVUS)-guided wiring enabled the successful treatment of a left circumflex ostial CTO with an impenetrable proximal cap.
Discussion:
An impenetrable proximal cap is an independent predictor of failure to cross with a guidewire during percutaneous coronary intervention for CTO. Our experience indicates that the "move the cap" technique can be performed more safely and effectively with IVUS-guided wiring.
Take-Home Messages:
An impenetrable proximal cap in CTO is linked to poorer outcomes in percutaneous coronary intervention. IVUS-guided wiring using the tip-detection method enables safer, more reliable application of the "move the cap" technique on proximal caps that are impenetrable.
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