Transvenous IVUS-guided percutaneous coronary intervention for chronic total occlusion: a novel strategy.

The major obstacle to successful recanalization of a chronic total occlusion (CTO) is difficulty in passing the guidewire through the occlusion. We report successful transvenous intravascular ultrasound (IVUS)-guided percutaneous coronary intervention for CTO of the coronary artery in two patients, one with CTO of the left circumflex artery and the other with CTO of the left anterior descending artery. The procedure involved the passage of a guidewire through the CTO lesion under fluoroscopic guidance and insertion of an IVUS catheter into the cardiac vein parallel to the target artery. Angiography after 8 months revealed no restenosis in either patient.