#KENSHI REVIEW SSS DOWNLOAD#
However, without constructing a 3D image, the guidewire tip cannot be positioned accurately, an unnecessarily large space is created that compresses the distal end of the CTO, and the possibility of advancing into a false lumen is increased.ĭownload Figure Download PowerPoint Figure 1 With construction of the 3D image, the guidewire tip can be accurately directed toward the target with minimum damage. Figure 1 illustrates the advantages of 3D wiring.
3D wiring involves rotating and advancing the guidewire by constructing a 3D image of its relationship to the target (i.e., the route within the CTO, the distal end of the CTO, or the retrograde wire) to determine which direction of rotation (clockwise or counterclockwise) provides the shortest route to the target. A guidewire can only be rotated in 2 directions, either clockwise or counterclockwise. We reported the methodology for 3D wiring previously (5). The 3D wiring technique is effective in the antegrade wiring but not in the retrograde wiring because the torque response of the retrograde guidewire cannot be maintained. Methodology of 3D wiring and experimental training model This study was performed to assess the efficacy and feasibility of the 3D wiring method during PCI for CTO in clinical practice to compare the procedural outcomes of CTO-PCI between the periods before and after the introduction of 3D wiring. Since then, we have performed the 3D wiring method during PCI for CTO in our clinical practice. Therefore, we developed a 3D wiring method to manipulate these stiff CTO-specific guidewires under real-time construction of a mental 3D image in 2015 (5). However, there have been no reports regarding this method because it is difficult to construct a real-time mental 3D image from 2-dimensional (2D) images obtained from the X-ray system monitor during PCI for CTO lesions. Therefore, using the images of 2 perpendicular angles from the X-ray monitor without IVUS guidance, intentional rotation with an image of clockwise/counterclockwise rotation while constructing a mental 3D image should be performed. Our clinical experience with IVUS-guided wiring for CTO lesions indicated that 3-dimensional (3D) imaging is important for accurate guidewire control.
We developed a CTO-specific intravascular ultrasound (IVUS) system, Navifocus WR, in partnership with Terumo Corp. Among the CTO-specific guidewires, the Conquest and Gaia guidewires (Asahi Intecc Co., Ltd., Aichi, Japan) enable accurate control in CTO lesions because of the excellent torque transmission and torque force. Dedicated coronary interventional cardiologists have developed several techniques and devices to improve the procedural outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions (1–3).