Intravascular ultrasound-guided chronic total occlusion wiring technique using 6 Fr catheters via bilateral transradial approach.

A blunt stump-type entry of chronic total occlusion (CTO) is one of the most difficult morphologic features to overcome in percutaneous coronary intervention (PCI), which often requires the guidance of intravascular ultrasound (IVUS) to identify the entry point. However, real-time, IVUS-guided PCI usually requires an 8 Fr guiding catheter. In this report, we describe a successful PCI for blunt stump CTO using bi-radial, IVUS-guided CTO wiring technique. Two 6 Fr guiding catheters (one as an operating guidewire; second for IVUS imaging) were simultaneously inserted into the left coronary artery via bilateral radial arteries. This technique may be useful for CTO intervention.