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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 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) | 0.000 | 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 teacher head, 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".