Abstract
Complete blockage of a coronary artery, called chronic total occlusion (CTO), frequently occurs due to atherosclerosis. To reopen the obstructed blood vessels with a stent, guidewire crossing is performed with the help of angiography that can provide the location of CTO lesions and the image of guidewire tip. Since angiography is incapable of imaging inside a CTO lesion, the surgeons are blind during guidewire crossing. For this reason, the success rate of guidewire crossing relies upon the proficiency of the surgeon, which is considerably reduced from 69.0% to 32.5% if extensive calcification, not penetrated by a guidewire, exists in CTO lesions. In this paper, a recently developed 40-MHz forward-looking intravascular ultrasound (FL–IVUS) transducer to visualize calcification within CTO lesions is reported. This transducer consists of a single element angled aperture and a guidewire passage. The aperture is spherically deformed to have a focal length of 3 mm in order to improve spatial resolution of FL–IVUS images. The angle between the beam direction and the axis of rotation is designed to be 30° to effectively visualize calcification within a CTO lesion as well as the blood vessel wall. The experimental results demonstrated that the developed FL–IVUS transducer facilitates visualization of calcification within CTO lesions and makes it possible to help the surgeon make decisions about whether to push the guidewire in order to cross the lesion or to change the surgical procedure.
Highlights
Atherosclerosis, a buildup of plaque in artery walls, develops gradually, causing arteries to narrow [1]
When a Chronic total occlusion (CTO) lesion is close to the transducer, the surgeons can predict from the forward-looking intravascular ultrasound (FL–intravascular ultrasound (IVUS)) image whether calcification is in the pathway of guidewire crossing
It was demonstrated that the 40-MHz FL–IVUS transducer consisting of a single element angled aperture and a guidewire passage can be used for visualization of calcification within
Summary
Atherosclerosis, a buildup of plaque in artery walls, develops gradually, causing arteries to narrow [1]. Chronic total occlusion (CTO), defined as complete blockage of a coronary artery, frequently occurs due to atherosclerosis; CTO was found in 33–50% of patients diagnosed with severe coronary artery disease in angiography [2]. New SL–IVUS transducers and imaging algorithms have been developed to further enhance its usefulness in clinics [4,5,6,7]. An SL–IVUS transducer integrated with optical fiber for photoacoustic imaging [9] have been developed to identify plaque compositions. For CTO lesion visualization, in contrast, angiography is the only diagnostic imaging tool commonly used in clinics. Since angiography can provide the location of CTO lesions and the image of guidewire tip, this imaging modality is useful for identifying
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