Work

Live IVUS-guided wiring in percutaneous coronary intervention: a case report

Year: 2026

Type: article

Abstract: Background Wiring in bifurcation percutaneous coronary intervention can be limited by severe angulation, adverse plaque biasing, and ostial ambiguity. Real-time intravascular ultrasound (RT-IVUS) guidance can augment wire manipulation when standard techniques fail. Case summary A 49-year-old man with exertional angina had a critical lesion left anterior descending (LAD)-2nd diagonal bifurcation lesion (Medina 1,1,0) with TIMI 2 flow. Standard wiring (acutely angled wires, dual lumen, and angled microcatheters) repeatedly biased into the diagonal. Under RT-IVUS, the wire was redirected into the true lumen of mid-LAD, enabling lesion crossing, pre-dilatation, and implantation of a 3.5 × 26 mm2 DES with post-dilatation. Final IVUS showed optimal expansion (MSA 9 mm2). The patient was discharged same day; at 3 months, he remained asymptomatic with a patent stent. Conclusion RT-IVUS can overcome wiring failure in complex bifurcations by providing live intravascular guidance augmenting wire passage into true lumen, supporting safe, efficient revascularization.

Source: European Heart Journal - Case Reports

DOI: 10.1093/ehjcr/ytag111

Authors: Rithik Mohan Singh Sindhi, Divyesh Sharma, Jack Andrews

Institution: Western Health and Social Care Trust

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $815