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Intravascular Imaging for Chronic Total Occlusion Intervention

  • Intravascular Imaging (MC Alraies, Section Editor)
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Abstract

Purpose of Review

We sought to summarize the current evidence on use of intravascular imaging (with intravascular ultrasound [IVUS] or optical coherence tomography [OCT]) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Recent Findings

Utilization of intravascular imaging in CTO PCI is increasing over time, both to facilitate CTO crossing and for optimization of the final result. OCT is used less often than IVUS due to its lower depth of penetration and need for contrast injection.

Summary

Intravascular imaging has multiple uses in CTO PCI: (a) it can facilitate CTO crossing by resolving proximal cap ambiguity and facilitating and confirming true lumen wire re-entry in case of initial subintimal wire crossing in both the antegrade and retrograde direction (for example by selecting the appropriate balloon size during the reverse controlled antegrade and retrograde tracking (reverse CART) technique; (b) it can be used to optimize the PCI result by ensuring good stent expansion and stent strut apposition, which may in turn result in lower rates of subsequent in-stent restenosis and stent thrombosis; (c) can facilitate evaluation and treatment of complications.

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Authors and Affiliations

  1. Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, MN, USA

    Iosif Xenogiannis, Peter Tajti, M. Nicholas Burke & Emmanouil S. Brilakis

  2. Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary

    Peter Tajti

  3. Department of Invasive Cardiology, Columbia University, New York, NY, USA

    Dimitri Karmpaliotis

  4. Department of Invasive Cardiology, San Giovanni Bosco Hospital, Turin, Italy

    Roberto Garbo

  5. Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy

    Andrea Gagnor

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  1. Iosif Xenogiannis
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  2. Peter Tajti
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  7. Emmanouil S. Brilakis
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Correspondence to Emmanouil S. Brilakis.

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Conflict of Interest

Dr. Karmpaliotis reports speaker honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions.

Dr. Garbo is a consultant for Philips Volcano Europe.

Dr. Burke is a consultant for Abbott Vascular and Boston Scientific.

Dr. Brilakis reports consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, and Medtronic; research support from Siemens, Regeneron, and Osprey. Shareholder: MHI Ventures. Board of Trustees: Society of Cardiovascular Angiography and Interventions.

All other authors declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Intravascular Imaging

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Xenogiannis, I., Tajti, P., Karmpaliotis, D. et al. Intravascular Imaging for Chronic Total Occlusion Intervention. Curr Cardiovasc Imaging Rep 11, 31 (2018). https://doi.org/10.1007/s12410-018-9471-3

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