11. Comparison of IVUS and angiography analysis before stenting in CTO lesions PCI

• Published in: Annales de cardiologie et d'angéiologie 2023-11, Vol.72 (5), p.101658, Article 101658
• Main Authors: Belfkih, A., Bressollette, A., Veugeois, A., Mahmoudi, K., Mamai, Z., Masri, A., Dandach, L., Amabile, N.
• Format: Article
• Language: English
• ISSN: 0003-3928
• DOI: 10.1016/j.ancard.2023.101658

Yet more accessible chronic total occlusion (CTO) lesions PCI remain technically challenging and associated with uncertain prognosis improvement and a higher risk of stent failure. However, most of these interventions are solely guided by angiography which can be often be misleading for the operator and leads to suboptimal results. In this perspective, the use of intracoronary imaging represents a valuable addition to improve outcomes. The aim of the present work was to compare the results of angiography and intra Vascular ultrasound (IVUS) in evaluation of successfully deoccluded CTO lesions. This series included patients with successfully deoccluded complex CTO lesions (median J CTO score 2 [1-2]) in our center from 2017 to 2022 that were treated with an antegrade wire escalation approach. After the lesion was crossed with wire and microcatheter, predilation was performed with a 2.0 compliant balloon and the lesion was analyzed by IVUS. The pre and post deocclusion angiography views as well as the pre/post stenting IVUS runs were centrally reviewed by an operator unaware of the procedure results. A dedicated software (CAAS 7.0, Pie Medical) was used for quantitative coronary angiography analysis (QCA). The following parameters were assessed: position of the wire (extraplaque /intraplaque), calcium burden & presence of calcified rings, vessel dimensions and lesion length. The series included a total of n=43 CTO lesions were located on LAD (39,5%), Cx (20,9%), and RCA (34,9%). The median J-CTO score was 2[1-2]. We observed significant discrepancies in wire position assessment between techniques: the wire was more frequently identified in extraplaque position with IVUS compared to angio (35.7% vs. 16.3%, p=0.001). The presence of extraplaque wire was associated with more complex procedures including higher volume of contrast (400 ml [350-510] vs 222 ml [195-273]; p