HD-IVUS-Guided Tip Detection–Antegrade Dissection and Re-Entry (TD-ADR)

We present a clinical case highlighting high-definition intravascular ultrasound (HD-IVUS)-guided tip detection-antegrade dissection and re-entry (ADR). This novel technique in percutaneous coronary intervention of chronic total occlusions was pioneered in Japan using a specially designed intravascular ultrasound catheter (AnteOwl WR IVUS, Terumo) and was replicated in this case using off-the-shelf equipment after antegrade and retrograde attempts with conventional methods were unsuccessful. To the best of our knowledge, this marks the first successful tip detection-ADR procedure performed using commercially available equipment in North America. Our experience shows that imaging-guided ADR can be a potentially helpful adjunctive strategy for challenging chronic total occlusion percutaneous coronary intervention.