Intravascular-ultrasound assisted localization and revascularization of an ostial chronic total occlusion: Utility of near-field and far-field imaging

Percutaneous coronary interventions (PCI) of chronic total occlusions (CTOs) can be technically challenging, but are valuable in patients with severe angina. Recently, algorithms for CTO-PCI have been proposed to facilitate the selection of the PCI approach that can best achieve procedural success. When the ostium of the occluded vessel is ambiguous or not well visualized, the success rate of antegrade approaches is significantly diminished. In our case, we demonstrate the utility of intravascular ultrasound imaging in the localization of an ambiguous or (stump-less) ostial CTO in addition to providing real-time far-field imaging, which is helpful in tracking wire progress through the occluded segment. Adjunctive imaging was instrumental in achieving procedural success using the antegrade approach.