Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains one of the most technically demanding procedures in interventional cardiology. Procedural success is highly dependent on accurate guidewire tracking; however, angiography alone is often insufficient to distinguish intraluminal from subintimal wire passage, potentially leading to dissection, perforation, or inappropriate stent deployment. Intravascular ultrasound (IVUS) provides real-time, high-resolution cross-sectional imaging that enables precise assessment of wire position and plaque morphology.
Case Presentation: We report a case of a 46-year-old male with triple-vessel coronary artery disease, including proximal right coronary artery (RCA) CTO, who underwent elective CTO PCI. Multiple antegrade wiring attempts raised concern for subintimal tracking. IVUS guidance confirmed true lumen navigation, enabling safe lesion preparation and optimal stent deployment. Final angiography demonstrated TIMI III flow without complications.
Conclusion: This case highlights the critical role of IVUS in confirming intraluminal guidewire position during complex CTO PCI. IVUS-guided PCI enhances procedural safety, optimizes stent placement, and should be considered standard practice in anatomically ambiguous or high-risk CTO lesions.
Keywords: Chronic total occlusion, IVUS, CTO PCI, intraluminal wiring, imaging-guided PCI.
How to cite this article: Prastowo RA, Oktaviono YH, Seeing Beyond The Wire : Intraluminal Navigation with IVUS in CTO PCI. Int J Drug Deliv Technol. 2026;16(2s): 271-272; DOI: 10.25258/ijddt.16.271-272