Convenience of Intravascular Ultrasound in Coronary Chronic Total Occlusion Recanalization

Abstract Even today, chronic total occlusion (CTO) revascularization constitutes a procedural challenge. Tapered stump CTO lesions are the ones with better success share, while blunt and vague stump (stumpless) CTO lesions have worse achievement because of the difficulty of anterograde to predict the guidewire course from the occluded point to the true distal lumen, especially those with a side branch arising from the occlusion. Still, when anterograde recanalization is not possible, retrograde recanalization constitutes an alternative challenge. Currently, the CTO lesions recanalization presents a high success rate (80%–90%) when reported by experienced operators. Intravascular ultrasound (IVUS) imaging can assist to differentiate a true lumen against subintimal space through recognizing the presence of side branches, intima and media (found in the true lumen, but not in the subintimal space). In addition, IVUS can confirm guidewire reentry to the true lumen from the subintimal space. IVUS-guided wiring technique may constitute one of the alternatives in the antegrade approach when standard wiring procedures fails. Also, anterograde IVUS may be beneficial in cases of retrograde approach.