There is no consensus on the optimal guidewire passage route for femoropopliteal (FP) chronic total occlusion (CTO). If intraplaque wiring can be performed, a stent-less strategy using a drug-coated balloon can be realized even with FP CTO, and there is a high possibility that good expansion can be obtained even when stent deployment is performed. AnteOwl WR (AnteOwl) is a novel intravascular ultrasound (IVUS) device useful for navigating the second guidewire into the intraplaque route under IVUS observation from the subintimal space. Here, we describe representative cases of FP CTO in which CTO-specific IVUS was extremely useful. Case 1 involved a 79-year-old man with total occlusion of the left superficial femoral artery (SFA). We used a contralateral antegrade approach, but the guidewire was advanced into the subintimal space. We advanced AnteOwl into the CTO. By utilizing the asymmetric structure of the transducer and the IVUS wire, we were able to reflect the positional relationship among the IVUS transducer, IVUS wire, and target plaque onto the angiographic image. By aiming the wiring in that direction, we succeeded in traversing the center of the plaque and finally succeeded in obtaining good expansion using the drug-coated balloon. Case 2 involved a 76-year-old woman with total occlusion from the SFA to the popliteal artery. We used an ipsilateral antegrade approach. When AnteOwl was placed on the wire and advanced to the popliteal artery, the subintimal space in the middle of the SFA could be visualized. We employed an IVUS-guided parallel wiring technique and succeeded in passing through all intraplaque routes. Although the CTO was long, we could easily advance through the intraplaque route by reflecting the information obtained from AnteOwl in angiography. AnteOwl is an effective IVUS for FP CTO and facilitates a complex IVUS-guided procedure.

中文翻译：

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使用 AnteOwl WR 血管内超声引导斑块内路径治疗股腘慢性完全闭塞的疗效


对于股腘动脉（FP）慢性完全闭塞（CTO）的最佳导丝通过路径尚未达成共识。如果可以进行斑块内布线，即使使用FP CTO也可以实现使用药物涂层球囊的无支架策略，并且即使进行支架展开也很有可能获得良好的扩张。 AnteOwl WR (AnteOwl) 是一种新型血管内超声 (IVUS) 设备，可用于在内膜下空间 IVUS 观察下将第二导丝引导至斑块内路径。在这里，我们描述了 FP CTO 的代表性案例，其中 CTO 特定的 IVUS 非常有用。病例 1 为一名 79 岁男性，左股浅动脉 (SFA) 完全闭塞。我们采用对侧顺行入路，但导丝被推进到内膜下空间。我们将 AnteOwl 提拔为 CTO。利用换能器和IVUS线的不对称结构，我们能够将IVUS换能器、IVUS线和目标斑块之间的位置关系反映到血管造影图像上。通过将布线对准该方向，我们成功地穿过斑块的中心，并最终成功地使用药物涂层球囊获得了良好的扩张。病例 2 是一名 76 岁女性，SFA 至腘动脉完全闭塞。我们采用同侧顺行入路。当 AnteOwl 放置在导线上并前进至腘动脉时，可以看到 SFA 中部的内膜下空间。我们采用 IVUS 引导的并行布线技术并成功穿过所有斑块内路线。尽管 CTO 很长，但通过在血管造影中反映从 AnteOwl 获得的信息，我们可以轻松地通过斑块内路线前进。 AnteOwl 是 FP CTO 的有效 IVUS，有助于复杂的 IVUS 引导程序。