Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach

Transcription

1 Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach Katsutoshi Takayama, MD, Ph.D Department of Radiology and Interventional Neuroradiology Ishinkai Yao General Hospital, Yao, Osaka, Japan

2 Disclosure Speaker name: Katsutoshi Takayama, M.D., ph. D I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest

3 What is Wire rendezvous technique? Bidirectional approach using two guidewires and microcatheters to recanalize for long CTO.

4 What is Wire rendezvous technique?

5 What is Wire rendezvous technique?

6 What is Wire rendezvous technique?

7 What is Wire rendezvous technique? Antegrade approach for recanalization is not successful.

8 What is Wire rendezvous technique?

9 What is Wire rendezvous technique?

10 What is Wire rendezvous technique? Retrograde approach for recanalization is not successful.

11 What is Wire rendezvous technique?

12 What is Wire rendezvous technique?

13 What is Wire rendezvous technique? Advance antegrade wire and retrograde micro into CTO lesion.

14 What is Wire rendezvous technique?

15 What is Wire rendezvous technique? Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).

16 What is Wire rendezvous technique?

17 What is Wire rendezvous technique?

18 What is Wire rendezvous technique? Advance antegrade micro beyond CTO segment.

19 What is Wire rendezvous technique? Advance antegrade micro beyond CTO segment.

20 What is Wire rendezvous technique? Exchange antegrade guidewire

21 What is Wire rendezvous technique?

22 What is Wire rendezvous technique?

23 What is Wire rendezvous Perform PTA. technique?

24 What is Wire rendezvous technique?

25 What's the key benefits? Minimize subintimal tracking Less traumatic for recanalization Goose neck wire is not necessary Much higher recanalization rate of long CTO

26 What is benefit of knuckle wire technique? Journal of Clinical and Diagnostic Research Sep, Vol-10(9):

27 What is benefit? Knuckle wire could be advanced within the sub-intimal space without perforation.

28 What is benefit? The loop could be advanced within the subintimal space without causing perforation. Technical success rate 86% Clinical success rate 80% Using inch wire J Endovasc Ther 2002;9:

29 Case Female / 80 year-old C/C : Ischemic rest pain (Fontaine classification: III, Rutherford category 4) P/Hx : DM, HL 7 years ago->medication Tx Percutaneous Coronary Intervention 6 years ago Laparoscopic cholecystectomy 7 years ago Stenting for bilateral SFA stenosis 1 years ago Stenting for bilateral CIA stenosis 1 years ago

30 CTA

31 CTA

32 CTA

33 long CTO of left BTK lesion 80F

34 long CTO of left BTK lesion 80F

35 My strategy in this case Firstly I try to cross ATA occlusion using microcatheter and inch guidewire by antegrade approach. After recanalization I try to cross peroneal artery occlusion using knuckle wire technique by retrograde collateral approach. And finaaly I planed to cross peroneal artery occlusion using Rendezvous technique.

36 Recanalization of left ATA occlusion

37 POBA for left ATA Rapid Cross 2.5/3mm x 21cm (Medtronic Inc, Minneapolis, MN)

38 POBA for left Popliteal artery Rapid Cross 2.5/3mm x 21cm

39 POBA for left popliteal artery Rapid Cross 2.5/3mm x 21cm

40 Post POBA

41 Post POBA

42

43 Collateral approach Prominent Bta, GT inch 45 angle

44 Collateral approach Prominent Bta GT inch 45 angle

45 Rendezvous Technique Retro : prominent Bta, Ante : prominent NEO GT inch 45 angle 135cm

46 Cross the lesion

47 POBA for peroneal artery occlusion PTA balloon 3mm x 15cm

48 POBA for peroneal artery occlusion PTA balloon 3mm x 15cm

49 Post PTA Post

50 Post

51 ABI Pre : 0.57 Post : 0.90 Post

52 Conclusion Wire rendezvous and retrograde knuckle wire technique by collateral approach may be safe and effective for the long CTO of BTK lesion.

53 Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach Katsutoshi Takayama, MD, Ph.D Department of Radiology and Interventional Neuroradiology Ishinkai Yao General Hospital, Yao, Osaka, Japan