Tip Detection Method Using the New IVUS Facilitates the 3-Dimensional Wiring Technique for CTO Intervention

Objectives The study assessed the efficacy of the tip detection method during intravascular ultrasound (IVUS)–based 3-dimensional (3D) wiring with a new chronic total occlusion (CTO)–specific IVUS system (AnteOwl IVUS [AO-IVUS]) for CTO percutaneous coronary intervention (PCI). Background The study developed angiography-based 3D wiring for CTO-PCI. Previously, the authors produced a short-tip CTO-specific IVUS system (Navifocus WR IVUS [Navi-IVUS]), which has been upgraded into the AO-IVUS system by adding a pullback transducer system for IVUS-based 3D wiring. Methods A CTO lesion 20 mm in length composed of 2.5% agar was experimentally inserted into the coronary artery of a beating heart model. The target (a microcatheter with a 0.6-mm lumen) was placed in the distal part of the CTO lesion. IVUS-guided wiring was performed to insert the guidewire into the target using the Navi-IVUS and then using the AO-IVUS 8 times each. In wiring with AO-IVUS, the IVUS-based 3D wiring using the tip detection method was performed. The crossing time and the number of punctures to the target were calculated. Results The crossing time was significantly shortened and the number of punctures was significantly reduced in AO-IVUS–based wiring compared with Navi-IVUS–based wiring (median crossing time 80.5 [interquartile range: 44.0 to 112.3] s vs. 333.0 [interquartile range: 88.8 to 790.0] s; p = 0.036; median 1.0 [interquartile range: 1.0 to 2.0] puncture vs. 24.0 [interquartile range: 5.8 to 52.5] punctures; p = 0.001). Conclusions The tip detection method enables the authors to easily perform the IVUS-based 3D wiring, and the new CTO IVUS system will facilitate this method in clinical practice.