Utility of Intravascular Ultrasound in Percutaneous Revascularization of Chronic Total Occlusions

Intravascular ultrasound has been used for >20 years to guide percutaneous coronary intervention in different subsets ofcoronary lesions. During the last decade, the interest in percutaneous coronary intervention for chronic total occlusion(CTO) has increased dramatically, leading to high success rates. Failure of guidewire crossing is the most common reason forfailed CTO attempts. Certain angiographic features, such as blunt proximal CTO cap, tortuosity, heavy calcification, and lackof visibility of path in the distal vessel, increase procedural difficulty. A better understanding of the behavior of theguidewire within the CTO segment may represent a key issue to achieve successful outcome. In this respect, intravascularultrasound imaging might have potential roles in the recanalization of CTOs. In this paper, we focused on the usefulnessand the applications of intravascular ultrasound imaging in percutaneous CTO recanalization, underlying its impact onclinical outcome. (J Am Coll Cardiol Intv 2016;9:1979–91) © 2016 by the American College of Cardiology Foundation