A tip detection method using a newly developed intravascular ultrasound-based three-dimensional (3D) wiring was found to superior to conventional method for chronic total occlusion-percutaneous coronary intervention, according to a study published in JACC Cardiovascular Interventions.

The AnteOwl is an upgrade from the Navifocus WR-intravascular ultrasound system, with the inclusion of a short tip and a pullback transducer system to improve the accuracy of chronic total occlusion-percutaneous coronary intervention. This guidewire navigation to the lumen is angiography-based and can be visualized by moving the transducer between the distal tip and the tip of the shaft. An experimental beating heart model and a chronic total occlusion lesion model with a target lumen at the distal part of the occlusion were used to test the efficacy of the system. Both systems were used to insert a guidewire and the crossing time and number of punctures needed to complete the procedure were assessed.

The median crossing times were 80.5 and 333.0 seconds with the AnteOwl-intravascular and the Navifocus WR-intravascular ultrasound systems, respectively (P =.036). The median number of punctures needed to reach the target were 1 and 24 with the AnteOwl-intravascular and the Navifocus WR-intravascular ultrasound systems, respectively (P =.001).

A case study of a woman in her seventies with stable angina pectoris was also presented. After a previously failed attempt to place a stent, the intravascular ultrasound-based 3D wiring using the tip detection method was performed, with the successful placement of 2 stents, which restored antegrade blood flow to normal.

Limitations of the study include the fact that the AnteOwl-intravascular ultrasound system is still not ready for clinical use.

 “The tip detection method enables us to easily perform the [intravascular ultrasound]-based 3D wiring, which will be further facilitated by the new [chronic total occlusion intravascular ultrasound] system (AnteOwl-intravascular ultrasound system),” concluded the study authors.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Okamura A, Iwakura K, Iwamoto M, et al. Tip detection method using the new IVUS facilitates the 3-dimensional wiring technique for CTO intervention [published online December 5, 2019]. JACC Cardiovasc Interv. doi:10.1016/j.jcin.2019.07.041