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Muhammad Wajahat Jan
Asmara Ali
Muhammad Shahjehan Mirza
Soban Abu Khifs
Muhammad Hamid
Retaj Alawadhi


Complex chronic total occlusions, IVUS-guided wiring re-entry technique, percutaneous coronary intervention


Background and Aim: Chronic total occlusions (CTOs) encountered in coronary angiography procedures pose a considerable contemporary challenge. Intravascular ultrasound (IVUS) emerges as a valuable asset in CTO, assisting in the attainment of successful outcomes. The utilization of intravascular ultrasound (IVUS) can prove beneficial in directing the subintimal guidewire back into the true lumen. This current study assessed the IVUS guidance wiring re-entry technique in managing complex chronic total occlusion (CTO) lesions.

Patients and Methods: This study encompassed 18 CTOs patients who underwent the IVUS-guided wiring re-entry technique in the department of cardiology, Lady Reading Hospital, Peshawar from February 2021 to February 2022. All the patients had a minimum of one chronic total occlusion (CTO) lesion and met the criteria for CTO lesion recanalization. A complete occlusion for >3 months within the blocked segment was considered as CTO. It guided the positioning of an additional inflexible wire to return to the genuine inner vessel channel, relying on either the neighboring side branch or the initial wire as points of reference, or utilizing the IVUS-guided parallel wire method.

Results: The overall mean age of the patients was 67.6 ± 10.7 years. Of the total 18 patients, there were 17 (94.4%) male and 1 (5.6%) female. A total of two patients, constituting 11.1% of the study cohort, had experienced prior unsuccessful attempts at vascularizing their chronic total occlusions (CTOs). The left ventricular ejection fraction and mean length of the occluded segment was 50.6 ± 11.4 and 62.8 ± 24.3 mm respectively. Among the patients studied, the morphology of the CTO stump was characterized as blunt in 16 individuals, making up 88.9% of the cases. Additionally, 12 patients (66.7%) exhibited moderate to severe calcification, while 10 patients (55.6%) had bridging collaterals. The IVUS guided wiring re-entry success rate was 88.9% (n=16 cases). The procedure did not result in any complications.

Conclusion: The present study found that the use of the IVUS-guided wire re-entry technique can assist the effective reopening of these CTO lesions while minimizing the occurrence of significant complications. Furthermore, this approach could potentially be related to favorable long-term clinical outcomes.

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