Abstract

Info

Title:: Application of intravascular ultrasound-guided antegrade dissection re-entry technique via distal branches in chronic total occlusions

Author(s):: JING Ran; ZHENG Lulu; ZHOU Zijing; QI Hong; Department of Cardiology, Xiangya Hospital, Central South University, Changsha 410008, China

Keywords:: Keywords: chronic total occlusion intravascular ultrasound antegrade dissection re-entry distal branch prognosis

Abstract:: An analysis is performed on the current status and advances of intravascular ultrasound-guided antegrade dissection re-entry via distal branches in percutaneous coronary intervention for chronic total occlusions (CTO). This study first elaborates on the clinical status of CTO and the crucial role of intravascular ultrasound in confirming the subintimal position of the guidewire, identifying the distal true lumen, determining the optimal re-entry point, and monitoring complications. Subsequently, it summarizes the existing clinical research evidence and analyzes the potential advantages of this strategy compared with traditional non-imaging-guided or proximal access antegrade dissection true lumen re-entry techniques, covering precautions for complex CTO patients (including those complicated with heart failure, renal dysfunction, or recurrent stent occlusion) and procedural strategies applicable when the distal branch-main vessel angulation is > 70° or ≤ 70°. Meanwhile, the limitations including the high requirements for equipments, potential increase in contrast agent usage, and radiation exposure are discussed. Finally, the future optimization directions (such as integration with new technologies) and application prospects of this technology are presented, aiming to provide evidence-based references for clinical practice.