Tip detection method adapted for identification of plaque localization during directional coronary atherectomy procedure
- PDF / 788,819 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 94 Downloads / 194 Views
IMAGES IN CARDIOVASCULAR INTERVENTION
Tip detection method adapted for identification of plaque localization during directional coronary atherectomy procedure Satoshi Suzuki1 · Atsunori Okamura1 · Hiroyuki Nagai1 · Katsuomi Iwakura1 · Ichiro Shiojima2 · Kenshi Fujii1 Received: 13 August 2020 / Accepted: 19 October 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Keywords Coronary intervention · DCA · IVUS · Tip detection method Abbreviations 3D Three-dimensional DCA Directional coronary atherectomy IVUS Intravascular ultrasound LAD Left anterior descending coronary artery RAO Right anterior oblique The side branch method, the guidewire vias method, and the coincided point method using the guidewire and the intravascular ultrasound (IVUS) transducer are all usually used to identify the plaque localization during directional coronary atherectomy (DCA) (NIPRO, Osaka, Japan). These methods cannot always be done where there is the plaque, therefore, decisions of the plaque localization are often inaccurate, and the test cut is required. We developed a tip detection method for IVUS-guided three-dimensional (3D) wiring in chronic total occlusion percutaneous coronary intervention [1]. This tip detection method can transfer 3D information from the IVUS image to the angiographic image at all coronary sites, therefore, it enables us to identify the precise plaque localization from the best angulation of the X-ray detector to perform DCA.
Case This case had severe stenosis at the ostium site of the left anterior descending coronary artery (LAD) (Fig. 1a), and AltaView IVUS (Terumo Corp. Tokyo, Japan) observation showed that the plaque was located between 6 and 9 o’clock (Fig. 1b). DCA for a proximal LAD lesion is usually performed from the right anterior oblique (RAO)caudal view to more easily produce a 3D image on the angiographic image (Fig. 1d-1). Therefore, from this view, the IVUS was advanced through the first guidewire and the tip of the second guidewire (SION) with the 1.5-mm curve at an angle of 45° was rotated counterclockwise to position the tip facing toward the operator at the just proximal site to the plaque (Fig. 1d-2, from left to right). Using the tip detection method, the angiographic direction of observation on the IVUS image was found to be facing 11 o’clock (Fig. 1d-2, left) and the IVUS image was rotated to bring this to 3 o’clock (Fig. 1d-3 right). The plaque was located between 9 and 2 o’clock (Fig. 1d-4), therefore, it could be easily understood that the plaque was located from the upper to the far side at the RAO-caudal view on angiographic images. Under angiographic guidance, the plaque was accurately removed by DCA and a stent was implanted from the ostium of the LAD while avoiding crossover stenting from the left main artery (Fig. 1c). This method is always useful except in cases of long or bent lesions which are also the same as in the current methods or in situations
* Atsunori Okamura a_okamura@watanabe‑hsp.or.jp 1
Division of Cardiology, Sakurabash
Data Loading...
