Using Intravascular Ultrasound To Optimize The Interventional Therapy For Coronary Chronic Total Occlusion

Objective :Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous coronary intervention(PCI)of chronic total occlusions(CTOs).An ambiguity stump CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring.Intravascular ultrasound images can clearly show the position of the stump of the CTO lesion and the pathological tissue of the stump,and guide the correct puncture of the wire into the CTO lesion,and finally complete the procedure.This study compared the effectiveness of IVUS guided intervention in the treatment of CTO.Methods:Between January 2016 and December 2017,there were84 cases which confirmed by angiography for ambiguity stemp CTO lesions and were treatedwith PCI in Xiang Tan central hospital.There were 48 cases which treated with IVUS "road map" method or real-time image guidancemethod to puncture proximal fibrous cap,and then used direct antegrade technology or non-direct antegrade(parallel wire and/or the LAST technology and/or the retragrade technology)technology to complete the PCI,were divided into IVUS group;The other 36 cases with angiogram imaging punctured proximal fibrous cap,and then then used direct antegrade technology or non-direct antegrade(parallel wire and/or the LAST technology and/or the retragrade technology)technology to complete the PCI,were divided intoangiography group.The number of direct antegrade cases in the two groups was compared.In the direct antegrade cases,the time of guidewire crossing through chronic total occlusion,procedure time and the amount of contrast were compared in the two groups.In the IVUS group,the relationship between the histopathological structure with the direct antegrade technique and non-direct antegrade technique were compared.Results:The IVUS group had a higher total successrate(91.67% vs 66.67% P<0.05)and direct antegrade success rate than the angiography group(60.42% vs 36.11% P<0.05).In the cases of direct antegrade success,the number of wires in the IVUS group was less than that of the angiography group(2.14±1.20 vs 3.25±0.93 P<0.05).In the IVUS group,the J-CTO score of "non-direct antegrade success" group was higher than the "direct antegrade success" group(3.53±0.74 vs 2.39±0.69 P<0.05).IVUS showed that there were more cases of high density plaque in " non-direct antegrade success" than "direct antegrade" group(66.67% vs.27.59%,P<0.05).Conclusion:IVUS can improve the direct antegrade success rate ofambiguity stump CTOs,which can reduce the use amount of the guide wire.In the IVUS group,the pathological histological features and anatomical features of the CTO lesion affect thedirect antegrade success rate of ambiguity stump CTOs.