Intravascular Ultrasound–Guided “Move the Cap” Technique for Heavily Calcified Ostial Chronic Total Occlusion
BACKGROUND: The "move the cap" technique is used to overcome ambiguous or impenetrable proximal caps in chronic total occlusion (CTO). CASE SUMMARY: We describe a case where intravascular ultrasound (IVUS)-guided wiring enabled the successful treatment of a left circumflex ostial CTO with an impenetrable proximal cap. DISCUSSION: An impenetrable proximal cap is an independent predictor of failure to cross with a guidewire during percutaneous coronary intervention for CTO. Our experience indicates that the "move the cap" technique can be performed more safely and effectively with IVUS-guided wiring. TAKE-HOME MESSAGES: An impenetrable proximal cap in CTO is linked to poorer outcomes in percutaneous coronary intervention. IVUS-guided wiring using the tip-detection method enables safer, more reliable application of the "move the cap" technique on proximal caps that are impenetrable.
Authors
- Tomohiro Yamasaki (ORCID: https://orcid.org/0000-0002-9858-9049)
- Mutsumi Iwamoto (ORCID: https://orcid.org/0009-0008-6232-8892)
- Yuta Nishimura
- Kota Tanaka (ORCID: https://orcid.org/0000-0002-5326-788X)
- Heitaro Watanabe
- Yoshitomo Tsutsui (ORCID: https://orcid.org/0009-0004-8006-1563)
- Kiwamu Sudo
- Satoshi Watanabe
- Masakazu Yasuda
- Atsunori Okamura
Institutions
- Sakurabashi Watanabe Hospital (JP)
Publication Details
- Journal
- JACC Case Reports
- Published
- 2026-05-01
- DOI
- https://doi.org/10.1016/j.jaccas.2026.108145
- Primary Topic
- Coronary Interventions and Diagnostics
- Type
- article
- Field-Weighted Citation Impact
- 0.00