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The role of intravascular imaging in chronic total occlusion percutaneous coronary intervention. | LitMetric

AI Article Synopsis

  • Chronic total occlusions (CTOs) are complex cases in coronary artery disease, making strategic planning for percutaneous coronary recanalization (PCI) crucial for successful outcomes and patient safety.
  • Intravascular ultrasound (IVUS) is preferred for CTO PCI due to its ability to penetrate deeper tissues and provide real-time imaging without contrast, assisting in wire re-entry and stent deployment.
  • Optical coherence tomography (OCT) plays a limited role, mainly in stent sizing and detecting issues like strut malapposition, but both imaging methods are vital for effective treatment of CTOs.

Article Abstract

Chronic total occlusions (CTOs) represent the most complex subset of coronary artery disease and therefore careful planning of CTO percutaneous coronary recanalization (PCI) strategy is of paramount importance aiming to achieve procedural success, and improve patient's safety and post CTO PCI outcomes. Intravascular imaging has an essential role in facilitating CTO PCΙ. First, intravascular ultrasound (IVUS), due to its higher penetration depth compared to optical coherence tomography (OCT), and the additional capacity of real-time imaging without need for contrast injection is considered the preferred imaging modality for CTO PCI. Secondly, IVUS can be used to resolve proximal cap ambiguity, facilitate wire re-entry when dissection and re-entry strategies are applied and most importantly to guide stent deployment and optimization post implantation. The role of OCT during CTO PCI is currently limited to stent sizing and optimization, however, due to its high spatial resolution, OCT is ideal for detecting stent edge dissections and strut malapposition. In this review, we describe the use of intravascular imaging for lesion crossing, plaque characterization and wire tracking, extra- or intra-plaque, and stent sizing and optimization during CTO PCI and summarize the findings of the major studies in this field.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520251PMC
http://dx.doi.org/10.3389/fcvm.2023.1199067DOI Listing

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