Tip detection-antegrade dissection and reentry using intravascular ultrasound in chronic total occlusion intervention: first human case report

Abstract

Background It has been considered impossible to perform antegrade dissection and reentry (ADR) by simply puncturing with a guidewire using the intravascular ultrasound (IVUS) observation without the support of the Stingray system. Case summary A 78-year-old man suffered from effort angina pectoris due to a chronic total occlusion (CTO) lesion in the left circumflex coronary artery. A retry percutaneous coronary intervention for the CTO lesion was attempted at our hospital. The J-CTO score was 3. The first guidewire entered the subintimal space. We moved onto StingrayADR using the angiographic observation, but the guidewire could not be led into the true lumen. AnteOwl WR-IVUS (AO-IVUS) observation revealed a distal true lumen in which the inner lumen was maintained 5 mm beyond the CTO exit. We decided to perform the tip detection-ADR using the AO-IVUS observation. The tip detection method allowed the tip of the penetration wire to puncture the wall between the subintima and the true lumen in an exactly vertical direction, resulting in the successful creation of a reentry point. The CTO lesion was dilated with one drug-eluting stent, and normal antegrade blood flow was achieved. Discussion Since the tip detection method enables accurate punctures, it may allow for ADR by simply puncturing using a guidewire. Due to this method being performed using the IVUS observation, it is likely more reliable than Stingray-ADR using the angiographic observation.

Intravascular ultrasound-guided dissection recanalization in a patient with ST-segment elevation myocardial infarction: a case report

“… 5 Okamura et al reported the efficacy of IVUS-guided TD-ADR in CTO PCI. 6 , 7 Here, we present the first use of IVUS-guided TD-ADR in AMI. In CTO cases, target visualization by contralateral injection is very important.…”

Efficacy of Intravascular Ultrasound–Based 3D Wiring Using the Tip Detection Method for CTO Intervention

“… 4 , 5 While performing this wiring, we first found in August 2021 that the TD method allows for antegrade dissection re-entry (ADR) because the wall between the subintima and the true lumen can be punctured at the intended part in an exactly vertical direction using the IVUS observation. We named this method “tip detection antegrade dissection re-entry (TD-ADR).” 6 …”