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Combination use of intravascular ultrasound and dual-lumen microcatheter guide for chronic total occlusion guidewire manipulation; A practical method

Author(s): Hidenori Komiyama*, , Masamichi Takano, Tomoyo Miyakuni, Takeshi Ikeda, Masato Matsushita, Toru Inami, Nobuaki Kobayashi, Yasushi Miyauchi, Yoshihiko Seino, Wataru Shimizu

Aim: To investigate the effectiveness of a new guidewire (GW) manipulation technique of combination of Intravascular Ultrasonography (IVUS) and dual-lumen microcatheter guidance. Methods: A 67 years old man presented with stump-less Chronic Total Occlusion (CTO) lesion in proximal part of Left Anterior Descending (LAD) coronary. By the combination use of IVUS and a dual-lumen microcatheter guide GW manipulation, GW successfully crossed the lesion. The efficacy was evaluated by the CTO model. Test 1 was used to determine which catheter is more suitable to obtain support force for penetration: the conventional IVUS-guide with single-lumen microcatheter or new IVUS-guide with dual-lumen microcatheter. Bench test 2 compared the proximity between CTO GW and IVUS catheter with conventional IVUS-guide and the new technique. Conventional IVUS guidance involved using a single-lumen microcatheter and IVUS cathetein, two separate GWs. The new technique involved using IVUS catheter and a dual-lumen microcatheter in the same GW. The CTO GW was manipulated through the over-the-wire lumen of the dual-lumen microcatheter. Results: In test 1, the dual lumen microcatheter supported successful GW penetration, whereas the single lumen did not. In test 2, the CTO GW was manipulated more proximally to the IVUS catheter with the new technique than with conventional IVUS guidance. Conclusion: The new technique is practical, as it provides more support force and more proximal visualisation than conventional IVUS guidance.

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