Some of the advantages of image-guided over-the-wire thrombectomy are listed below:
A larger catheter and balloon can be safely used when inflation is guided by visualization, avoiding the use of multiple catheters and balloons.
Variable inflation avoids endovascular trauma and dissection.
Balloon deformation is a “local arteriogram”, pinpointing diseased areas for detailed imaging or direct treatment.
Wire passage prior to catheter deployment is a strong indicator of embolic or thrombo-stenotic etiology. The ability to pass a wire is strong predictor of outcome. A variety of techniques can be employed to traverse lesions inaccessible to a catheter alone.
Distal positioning of the balloon is made possible by wire and image guidance. This prevents multiple passes with an inflated balloon and increases the likelihood of complete treatment with a single balloon pass.
The infusion of local contrast or therapeutic agents is accomplished by gentle inflation of the balloon and delivery of the agent through the wire lumen. This allows for lower volume but more concentrated contrast or therapeutic agent (e.g. thrombolytic agents, nitroglycerin, etc.).
The access site can be chosen with more freedom since the proximity to branch points is not as crucial to catheter passage using selective over-the-wire catheterization techniques. For example, there is no need to expose the distal popliteal to approach tibial vessels.