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Fig. 4 | CVIR Endovascular

Fig. 4

From: An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries

Fig. 4

Schematic diagram of extreme antegrade guidewire crossing by AnteOwl WR intravascular ultrasound (IVUS)-guided parallel wiring to a below-the-knee artery (EXCAVATOR). A The 1st guidewire (GW) with microcatheter is advanced into the subintima. We use the bougie technique with the microcatheter to prepare for IVUS insertion. B The AnteOwl IVUS is advanced along the 1st GW. The 2nd GW with microcatheter is inserted to perform IVUS-guided parallel wiring. The 2nd GW is guided to the intraplaque under real-time IVUS guidance. The 2nd GW is then advanced into the subintima. C The bougie technique is used as shown in (A) and the IVUS is returned to the subintima. Under IVUS guidance, the 2nd GW is again introduced into the plaque. D Finally, the 2nd GW is passed from the distal plaque to the distal true lumen

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