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Case report highlights improved outcomes with intravascular ultrasound-guided wiring in chronic total occlusion treatment, implying a safer approach.
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.
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Sudo et al. (2026) studied this question.
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