Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries
Abstract Background Revascularization with endovascular therapy (EVT) for complex below-the-knee (BTK) chronic total occlusion (CTO) remains a challenging problem. The Japanese-BTK (J-BTK) CTO score is reported as an indicator of the difficulty of BTK CTO, with the guidewire (GW) passage success rat...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-10-01
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| Series: | CVIR Endovascular |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42155-023-00399-2 |
| _version_ | 1797451330447474688 |
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| author | Naoki Hayakawa Satoshi Kodera Hiromi Miwa Shinya Ichihara Satoshi Hirano Masataka Arakawa Yasunori Inoguchi Shunichi Kushida |
| author_facet | Naoki Hayakawa Satoshi Kodera Hiromi Miwa Shinya Ichihara Satoshi Hirano Masataka Arakawa Yasunori Inoguchi Shunichi Kushida |
| author_sort | Naoki Hayakawa |
| collection | DOAJ |
| description | Abstract Background Revascularization with endovascular therapy (EVT) for complex below-the-knee (BTK) chronic total occlusion (CTO) remains a challenging problem. The Japanese-BTK (J-BTK) CTO score is reported as an indicator of the difficulty of BTK CTO, with the guidewire (GW) passage success rate decreasing as the grade increases. We previously reported an effective GW crossing method for the intravascular ultrasound (IVUS)-guided parallel wiring of complex BTK CTO. In this study, we investigated the feasibility of EVT using IVUS-guided wiring for BTK CTO. Materials and methods This single center, retrospective study analyzed 65 consecutive BTK CTO vessels in which IVUS-guided wiring was attempted after the failure of a conventional antegrade wiring approach from November 2020 to November 2022. The primary endpoint was the clinical success of the target CTO vessel. The secondary endpoints were the GW success rate per grade based on the J-BTK CTO score, number of GW used for CTO crossing, fluoroscopy time, and complications. Results Target vessels were the anterior tibial artery (66.2% of cases), peroneal artery (9.2%), and posterior tibial artery (24.6%). Blunt type CTO entry was performed in 55.4% of cases, calcification of entry was observed in 24.6% of cases, the mean occlusion length was 228.2 ± 93.7 mm, mean reference vessel diameter was 2.1 ± 0.71 mm, and outflow was absent in 38.5% of cases. J-BTK CTO scores of 0/1 (grade A), 2/3 (grade B), 4/5 (grade C), and 6 (grade D) were seen in 18.5%, 43.1%, 36.3%, and 1.5% of cases, respectively. The clinical success rate was 95.4%. The GW success rate by J-BTK CTO grade was as follows: grade A (100%), B (100%), C (91.7%), and D (0%). The mean number of GW used was 3.4 ± 1.4, the mean fluoroscopy time was 72.3 ± 32.5 min, and complications occurred in 7.7% of cases. Conclusion This study showed a very high clinical success rate despite the difficulty of BTK CTO. IVUS-guided EVT might be a feasible strategy for complex BTK CTO. |
| first_indexed | 2024-03-09T14:53:07Z |
| format | Article |
| id | doaj.art-46808d47619148eca35fd0b3a5b7cbe8 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-03-09T14:53:07Z |
| publishDate | 2023-10-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-46808d47619148eca35fd0b3a5b7cbe82023-11-26T14:20:41ZengSpringerOpenCVIR Endovascular2520-89342023-10-01611910.1186/s42155-023-00399-2Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteriesNaoki Hayakawa0Satoshi Kodera1Hiromi Miwa2Shinya Ichihara3Satoshi Hirano4Masataka Arakawa5Yasunori Inoguchi6Shunichi Kushida7Department of Cardiovascular Medicine, Asahi General HospitalDepartment of Cardiovascular Medicine, The University of Tokyo HospitalDepartment of Cardiovascular Medicine, Asahi General HospitalDepartment of Cardiovascular Medicine, Asahi General HospitalDepartment of Cardiovascular Medicine, Asahi General HospitalDepartment of Cardiovascular Medicine, Asahi General HospitalDepartment of Cardiovascular Medicine, Asahi General HospitalDepartment of Cardiovascular Medicine, Asahi General HospitalAbstract Background Revascularization with endovascular therapy (EVT) for complex below-the-knee (BTK) chronic total occlusion (CTO) remains a challenging problem. The Japanese-BTK (J-BTK) CTO score is reported as an indicator of the difficulty of BTK CTO, with the guidewire (GW) passage success rate decreasing as the grade increases. We previously reported an effective GW crossing method for the intravascular ultrasound (IVUS)-guided parallel wiring of complex BTK CTO. In this study, we investigated the feasibility of EVT using IVUS-guided wiring for BTK CTO. Materials and methods This single center, retrospective study analyzed 65 consecutive BTK CTO vessels in which IVUS-guided wiring was attempted after the failure of a conventional antegrade wiring approach from November 2020 to November 2022. The primary endpoint was the clinical success of the target CTO vessel. The secondary endpoints were the GW success rate per grade based on the J-BTK CTO score, number of GW used for CTO crossing, fluoroscopy time, and complications. Results Target vessels were the anterior tibial artery (66.2% of cases), peroneal artery (9.2%), and posterior tibial artery (24.6%). Blunt type CTO entry was performed in 55.4% of cases, calcification of entry was observed in 24.6% of cases, the mean occlusion length was 228.2 ± 93.7 mm, mean reference vessel diameter was 2.1 ± 0.71 mm, and outflow was absent in 38.5% of cases. J-BTK CTO scores of 0/1 (grade A), 2/3 (grade B), 4/5 (grade C), and 6 (grade D) were seen in 18.5%, 43.1%, 36.3%, and 1.5% of cases, respectively. The clinical success rate was 95.4%. The GW success rate by J-BTK CTO grade was as follows: grade A (100%), B (100%), C (91.7%), and D (0%). The mean number of GW used was 3.4 ± 1.4, the mean fluoroscopy time was 72.3 ± 32.5 min, and complications occurred in 7.7% of cases. Conclusion This study showed a very high clinical success rate despite the difficulty of BTK CTO. IVUS-guided EVT might be a feasible strategy for complex BTK CTO.https://doi.org/10.1186/s42155-023-00399-2Chronic total occlusionEndovascular therapyIntravascular ultrasoundBelow-the kneeScoring system |
| spellingShingle | Naoki Hayakawa Satoshi Kodera Hiromi Miwa Shinya Ichihara Satoshi Hirano Masataka Arakawa Yasunori Inoguchi Shunichi Kushida Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries CVIR Endovascular Chronic total occlusion Endovascular therapy Intravascular ultrasound Below-the knee Scoring system |
| title | Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries |
| title_full | Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries |
| title_fullStr | Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries |
| title_full_unstemmed | Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries |
| title_short | Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries |
| title_sort | clinical feasibility of endovascular recanalization with intravascular ultrasound guided wiring for chronic total occlusion of below the knee arteries |
| topic | Chronic total occlusion Endovascular therapy Intravascular ultrasound Below-the knee Scoring system |
| url | https://doi.org/10.1186/s42155-023-00399-2 |
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