S. Arain - Flash Highlights: Optimizing results: Intravascular imaging in CTO PCI
- 1. Optimizing Results: IVUS Imaging in CTO PCI Or, Ten Ways To Use IVUS In Your Next CTO PCI! Salman A. Arain, MD Associate Professor, Department of Medicine - Cardiology Program Director, Interventional Cardiology Fellowship McGovern School of Medicine University of Texas, Houston, Texas
- 2. Disclosures • Boston Scientific: Speaker’s Bureau, Medical Advisory Board
- 3. Rationale for IVUS CTO PCI • CTO PCI is technically very challenging • One reason for this is ambiguity of vessel architecture and course • IVUS allows real time, contrast free evaluation of the target lesion/vessel • It can facilitate all aspects of CTO PCI: • Cap puncture, CTO crossing, distal re-entry, stent optimization
- 4. IVUS During CTO PCI: The Data • IVUS use varies between operators • Factors: availability, cost, familiarity, experience • US/Europe: 12 - 37% • Japan/Korea: 39 - 48% • Use is increasing Xenogiannis et al. Front Cardiovasc Med 2023 Karacsonyi et al. JAHA 2016
- 5. When Should You Use IVUS • CTO PCI involves solving many small problems • IVUS can be helpful at all stages • During crossing: Most beneficial in negotiating the proximal and distal cap crossing • After crossing: Wire position and stent optimization
- 6. Ten Ways To Use IVUS During CTO PCI
- 7. 1. Resolve Cap Ambiguity Proximal Cap ? Courtesy of Simon Walsh BASIC
- 8. 1. Resolve Cap Ambiguity Proximal Cap ? Disease-free, Sub-2mm DIameter Proximal cap Of LAD appearing Observe step-up In dIameter Septal vessel appears 5-6 o’clock Fibro-calcific, eccentric lesion BASIC
- 9. 2. IVUS Guided Cap Puncture Galassi et al. JACC Inter 2023 ADVANCED
- 10. 2. IVUS Guided Cap Puncture Xenogiannis et al. Front Cardiovasc Med 2023 ADVANCED
- 11. 3. IVUS Guided Reverse CART Xenogiannis et al. Front Cardiovasc Med 2023 INTERMEDIATE
- 12. 3. IVUS Guided Reverse CART Xenogiannis et al. Front Cardiovasc Med 2023 INTERMEDIATE
- 13. 4. IVUS Guided Parallel Wiring ADVANCED
- 14. 5. IVUS During In-stent CTO PCI 1 3 2 6 5 4 BASIC Courtesy of Simon Walsh
- 15. 5. In-stent CTO PCI Courtesy of Simon Walsh BASIC
- 16. 6. IVUS Guided Re-entry Galassi et al. JACC Inter 2023 INTERMEDIATE
- 17. 7. Tip Detection ADR ADVANCED Tanaka et al. JACC Inter 2023
- 18. 8. Resolve Distal Bifurcations BASIC
- 19. 8. Resolve Distal Bifurcations BASIC
- 20. 9. Determine Wire Course BASIC
- 21. 9. Determine Wire Course BASIC
- 22. 10. Optimize Stent Deployment Xenogiannis et al. Front Cardiovasc Med 2023 BASIC
- 23. Conclusions • IVUS can facilitate CTO PCI - particularly in complex lesion subsets • Offers several advantages over angiography alone 1. Improves efficiency 2. Maximizes procedural success 3. May improve safety 4. Optimizes long-term outcomes • It is an essential skill for the CTO operator
- 24. Optimizing Results: IVUS Imaging in CTO PCI Or, Ten Ways To Use IVUS In Your Next CTO PCI! Salman A. Arain, MD Associate Professor, Department of Medicine - Cardiology Program Director, Interventional Cardiology Fellowship McGovern School of Medicine University of Texas, Houston, Texas