CART h i l ili CTOCART technique to treat long iliac CTO

Hidetsugu Sakai, MD.

Shogo Imagawa, MD.

, PhD.

, PhD.g g ,Mikito Nishikawa, MD.

Junichi Matsumoto, MD.

,

Junichi Matsumoto, MD.

Keishi Ushijima, MD.

C th t i ti L b t D t t f C di l M di iCatheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

Case60‘s maleDiagnosis : ASODiagnosis : ASOHistory

He began to complain of intermittent claudication 2 years before and the symptom had deteriorated gradually.

Ph i l i tiPhysical examinationLeft femoral artery: weakly palpableRi ht f l t l t t l blRight femoral artery: almost not palpableAnkle-Brachial index: 0.50 (right), 0.70 (left)No cyanosisy

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

AGRight iliac artery was totally occluded.

Left external iliac arterywas severely stenosed.

There were not any significant lesionsbelow femoropopliteal arteries.

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

1st EVTPRE POST

SMART Control8.0-60mm

SMART Control6 0-40mm6.0-40mm

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

2nd EVTBrite-Tip sheath introducer 6Fr-90cm

from left brachial artery

Whole length of rt iliac artery was CTO.

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

2nd EVTIpsilateral retrograde approach was tried.

A neo’s Treasure was advancedA neo s Treasure was advancedwith a 4.0-40mm Sterling-OTW.

’ T h dneo’s Treasure was exchangedto neo’s Astato

Th id i f ll dThe guidewire successfully crossed lesion ?But it went wrong into subintimal space…..

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

2nd EVTBi-directional approach was essential !

A th ’ A t t t d lAnother neo’s Astato was antegradelyadvanced with a 150cm Rapid-Transit.

R d l d d S liRetrogradely advanced Sterling was inflated to make antegrade guidewire track the subintimal space.

Antegrade neo’s Astato successfully crossed the lesion.

A 300cm Deja-Vu was advancedacross the whole length of the lesion.

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

across the whole length of the lesion.

2nd EVTPredilatation was performed

using a 6.0-40mm Aviator-plus.

Antegrade flow was well restored,but major dissections were found.

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

2nd EVTA 7.0-100mm Smart-Control stent

was deployed at distal lesion.

A 8.0-60mm Smart-Control stentwas deployed at proximal lesion.

Postdilatation was performedusing the previous Aviator-plus.

The lesion was well dilatedwithout any complications.without any complications.

Postprocedural ABI: rt 1.02, lt 1.07

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

ConclusionIt is well known that significant restenosis is rare in the field of iliac artery stenting.According to this concrete evidence, endovascular treatment is preferable even if target lesion is totally occlusive.But surgical treatment is still recommended in the case ofBut surgical treatment is still recommended in the case of diffusely occlusive disease, such as TASC-II type-D lesions.Device improvement and technical refinement are essentialDevice improvement and technical refinement are essential to bring the benefits of EVT to patients of tough diseases.Although controlled antegrade and retrograde subintimal t ki th t i CART t h i i t d t t ttracking, that is CART technique, was invented to treat coronary CTO lesions, it is also of much use in the field of those of peripheral artery.

Catheterization Laboratory, Department of Cardiovascular MedicineKushiro City General Hospital, Kushiro, Japan

those of peripheral artery.