Real-Time Intravascular Ultrasound-Guided Wiring for Percutaneous Coronary Intervention of Abrupt-Type Chronic Total Occlusion

The success rate of a chronic total occlusion (CTO) procedure depends on the morphologic features of the lesion. The abrupt type of CTO, which has a blunt stump with a side branch at the site of occlusion, is suggested to be a predictor of procedure failure. We report a successful recanalization of the abrupt type of CTO by using real-time intravascular ultrasound (IVUS)-guided wiring technique in a 51-year-old gentleman. By IVUS imaging, the stiff guide wire was guided to penetrate a presumed proper site of the proximal cap, in this case the central calcified part, instead of the more marginal non-calcified portion of the proximal cap. IVUS is useful not only to look for the proper entrance of the proximal cap of CTO from a sideways view, but also to decide the stent size and distal landing zone after recanalization of CTO.