A comparative study of chronic total occlusion-percutaneous coronary intervention with and without intravascular ultrasound-guided wiring with respect to acute procedural outcome: A single center experience

Background: Chronic total occlusions (CTOs) are a significant challenge in interventional cardiology, with percutaneous coronary intervention (PCI) for CTOs often exhibiting lower success rates and higher complication rates compared to non-CTO lesions. Intravascular ultrasound (IVUS) is a promising imaging modality that can improve procedural outcomes, particularly during the wiring phase of CTO-PCI. Aims and Objectives: This study aims to compare the effectiveness of IVUS-guided wiring versus conventional angiography-guided techniques in CTO-PCI, focusing on procedural success fluoroscopic time, contrast volume, and procedural complications. Materials and Methods: A total of 60 patients with angiography-confirmed CTO were enrolled and divided into two groups: Thirty patients in the IVUS-guided group and 30 in the angiography-guided group. The procedural outcomes, including procedural success in terms of wire passage, fluoroscopy time, contrast volume, and complication rates, were evaluated. Results: The mean age of patients was 58.1 years, and 73.3% were male. The procedural success rate was significantly higher in the IVUS group (76.7%) compared to the angiography group (43.33%, P=0.017). The average fluoroscopy time was significantly shorter in the IVUS-guided group (0.82 h) compared to the angiography-guided group (1.447 h, P<0.001). Similarly, the IVUS group used significantly less contrast (97.5 mL) compared to the angiography group (185.17 mL, P<0.001). Complications were fewer in the IVUS group (13.3% had complications) compared to the angiography group (40%, P<0.05). Conclusion: IVUS guidance significantly improved procedural success, reduced fluoroscopy time and contrast volume, while reducing complications in CTO-PCI procedures. These findings suggest that IVUS should be routinely incorporated into CTO-PCI to enhance procedural efficiency, minimize contrast and radiation exposure, and improve patient safety.