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.
Sudo et al. (Mon,) studied this question.