Real-Time IVUS-Guided Wiring With a Dual-Lumen Microcatheter for Blunt Proximal Cap CTO: Procedural Technique and Comparative Outcomes.
TL;DR
Real-time IVUS-guided wiring using a conventional pull-back IVUS system with a dual-lumen microcatheter was feasible in selected blunt proximal cap CTO lesions and may offer a practical option for resolving proximal cap ambiguity.
Abstract
Background
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) with blunt proximal caps is technically challenging due to unclear vessel morphology. Real-time intravascular ultrasound (IVUS) guidance can improve wire entry accuracy; however, its application with conventional pull-back IVUS systems remains underinvestigated.
Aims
To evaluate the feasibility and outcomes of real-time IVUS-guided wiring for blunt proximal cap CTO PCI.
Methods
We retrospectively analyzed patients who underwent PCI for blunt-cap CTOs between January 2020 and December 2024. Patients were categorized into IVUS-guided and angiography-guided wiring groups based on the initial strategy. The IVUS-guided approach employed a conventional pull-back IVUS system with a shaft-mounted transducer, advanced into a side branch, alongside a dual-lumen microcatheter positioned on the same wire to facilitate real-time imaging. In-hospital events and follow-up clinical outcomes were assessed. Overlap weighting based on propensity scores was applied to balance baseline and angiographic characteristics between groups.
Results
Of 152 patients, 17 underwent IVUS-guided wiring and 135 underwent angiography-guided wiring. The IVUS-guided group demonstrated reduced use of parallel wiring and retrograde techniques. Procedural success rates were high in both groups. Complete revascularization was numerically more frequent in the IVUS-guided group. Over 15.4 ± 6.9 months, the IVUS-guided group showed numerically lower rates of adverse clinical events, though the study was underpowered to detect definitive differences.
Conclusions
Real-time IVUS-guided wiring using a conventional pull-back IVUS system with a dual-lumen microcatheter was feasible in selected blunt proximal cap CTO lesions. When a suitable side branch is available, this technique may offer a practical option for resolving proximal cap ambiguity.