Applications for Intravascular Ultrasound in Chronic Total Occlusions

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Applications for Intravascular Ultrasound in Chronic Total Occlusions Barry D. Rutherford, MD Saint Luke’s

Applications for Intravascular Ultrasound in Chronic Total Occlusions Barry D. Rutherford, MD Saint Luke’s Mid America Heart Institute Kansas City, Missouri, USA CRT 2012

IVUS Use in CTO Stenting • Identify entry point to proximal cap • Vessel

IVUS Use in CTO Stenting • Identify entry point to proximal cap • Vessel sizing/stent apposition • Avoid longitudinal geographic miss • Identification of true vs. false lumen (CART Technique) • Development of forward looking IVUS Used in 100% of cases

Forward Looking IVUS: Field of View Angled IVUS transducer rotates, making cone shaped image

Forward Looking IVUS: Field of View Angled IVUS transducer rotates, making cone shaped image

Forward Looking IVUS: Field of View 5 mm radius 5 mm forward 1 mm

Forward Looking IVUS: Field of View 5 mm radius 5 mm forward 1 mm • 5 mm forward • 5 mm to the side • “Tick marks” are 1 mm in cross-sectional plane for easy diameter sizing • This vessel is 9 mm across Investigational Device, not for human use

65 -yo Male CTO of LAD IVUS ID of proximal cap

65 -yo Male CTO of LAD IVUS ID of proximal cap

65 -yo Male CTO of LAD IVUS ID of proximal cap

65 -yo Male CTO of LAD IVUS ID of proximal cap

65 -Year. Old Male CTO of RCA Failed Previous Antegrade Attempt

65 -Year. Old Male CTO of RCA Failed Previous Antegrade Attempt

VESSEL SIZING WITH IVUS 62 -yo Female CTO of RCA

VESSEL SIZING WITH IVUS 62 -yo Female CTO of RCA

62 -yo Female: CTO of RCA Following initial balloon dilatation Assessment of distal vessel

62 -yo Female: CTO of RCA Following initial balloon dilatation Assessment of distal vessel size

62 -yo Female: CTO of RCA 3. 8 mm Distal Vessel 4. 2 mm

62 -yo Female: CTO of RCA 3. 8 mm Distal Vessel 4. 2 mm Mid Vessel

62 -yo Female: CTO of RCA Post Stenting Angiogram 4. 0 x 28 mm

62 -yo Female: CTO of RCA Post Stenting Angiogram 4. 0 x 28 mm DES 3. 5 x 28 mm DES

63 -yo male CTO of RCA

63 -yo male CTO of RCA

63 -Year-Old Male – CTO of RCA IVUS Evaluation Post PTCA 3. 4 3.

63 -Year-Old Male – CTO of RCA IVUS Evaluation Post PTCA 3. 4 3. 8 4. 2 3. 6

63 -yo male CTO of RCA

63 -yo male CTO of RCA

63 -Year-Old Male – CTO of RCA IVUS Evaluation Post Stenting CSA 10. 1

63 -Year-Old Male – CTO of RCA IVUS Evaluation Post Stenting CSA 10. 1 mm 2

LONGITUDINAL GEOGRAPHIC MISS 59 -Year-Old Male; CTO of LCX 3/23/06 CTO of LCX 2.

LONGITUDINAL GEOGRAPHIC MISS 59 -Year-Old Male; CTO of LCX 3/23/06 CTO of LCX 2. 75 x 28 mm Cypher

59 -Year-Old Male CTO of LCX 7/27/06 In-Segment Restenosis

59 -Year-Old Male CTO of LCX 7/27/06 In-Segment Restenosis

IVUSGuided Reverse CART Setup

IVUSGuided Reverse CART Setup

IVUSGuided Reverse CART Channel Wiring Fielder FC Subintimal or intraplaque microchannel?

IVUSGuided Reverse CART Channel Wiring Fielder FC Subintimal or intraplaque microchannel?

IVUS-Guided Reverse CART Antegrade IVUS True Lumen Intraplaque Subintimal 3. 2 mm

IVUS-Guided Reverse CART Antegrade IVUS True Lumen Intraplaque Subintimal 3. 2 mm

IVUS-Guided Reverse CART 3 gm Miracle 3. 0 x 15 balloon Fielder FC Corsair

IVUS-Guided Reverse CART 3 gm Miracle 3. 0 x 15 balloon Fielder FC Corsair channel dilator

IVUS-Guided Reverse CART Anchor for catheter exchange Trap Finecross catheter 3 gm Miracle Bros

IVUS-Guided Reverse CART Anchor for catheter exchange Trap Finecross catheter 3 gm Miracle Bros 300 cm

IVUSGuided Reverse CART

IVUSGuided Reverse CART