Intravascular Ultrasound Findings Associated With Hydrodynamic Contrast Recanalization (HDR) of Coronary Chronic Total Occlusions
Bibliographic record
Abstract
BACKGROUND: Hydrodynamic contrast recanalization (HDR) is a novel technique to facilitate wire crossing during chronic total occlusion (CTO) percutaneous coronary interventions (PCI). The mechanisms underlying HDR have not been fully described. AIMS: To investigate the impact of HDR on plaque morphology and wire tracking during CTO PCI using intravascular ultrasound (IVUS) imaging. METHODS: We identified 35 patients who underwent successful HDR and IVUS-guided CTO PCI at our institution between January 2023 and December 2024. We collected the following from IVUS images: wire position (intraplaque vs. extraplaque) within the CTO segment, plaque morphology, and evidence of vascular injury (intramural hematoma or dissection). RESULTS: Immediate post-HDR IVUS images were available for analysis in all 35 patients. IVUS imaging revealed intraplaque guidewire crossing in 91% (n = 32) of cases. Intraplaque speckling, which we have termed the "Starry Sky" sign, was observed in 24 cases (68%), and intramural hematoma was found in 11 cases (31%). Four dissections were detected: two precluded direct distal wire re-entry necessitating the use of non-HDR techniques (94% technical success). The overall procedural success rate was 100%, and there were no PCI-related complications (perforation, myocardial infarction, or death). CONCLUSIONS: HDR is a novel CTO PCI technique that appears to facilitate intraplaque wire crossing without causing significant vessel injury. The presence of speckled plaque by IVUS is a unique feature of HDR that may suggest a mechanism underlying this technique. Additional studies are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".