Cardiologists do magic inside the human coronary artery , that too in a live beating heart , unlike the surgeons.Blocks are removed , holes are closed, valves are inserted , scars are burnt, new electrical connections are laid .They do this with relative blind vision with good degree of success. Still, as we aim for more precise interventions we require excellent imaging modalities to assist us.
In PCI of CTO(Chronic total occlusion) the critical element to know is the morphology of the tissue plane , what exactly we burrow ? as we navigate through complex, often hard shapeless tortuous tissue tunnels . Our patients will be surprised to know we are currently doing this with our eyes shut. If only we have a camera guide in the tip of the wire it give us tremendous advantage .
The CTO morphology .Image source : Kenichi Sakakura ,Eur Heart J. 2014 Jul 1;35(25):1683-93.
The exiting IVUS technology can only look sideways . Now a new vision is added by annular array of transducer at tip with CMOS sensor .The technology is just coming out it would be use for us in the near future .
Anatomy of the forward looking ultrasonic eye
Reference
Dr.S.Venkatesan MD 