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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
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
What is Wire rendezvous technique ?
・ Bidirectional approach using two guidewires and microcatheters to recanalize for long CTO.
What is Wire rendezvous technique ?
What is Wire rendezvous technique ?
・Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).
What is Wire rendezvous technique ?
・Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).
What is Wire rendezvous technique ?
What is Wire rendezvous technique ?
What is Wire rendezvous technique ?
・Advance antegrade microcatheter
beyond CTO segment.
What is Wire rendezvous technique ?
・Advance antegrade microcatheter
beyond CTO segment.
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
What is benefit of retrograde knuckle wire technique?
Journal of Clinical and Diagnostic Research. 2016 Sep, Vol-10(9):
What's the key benefits?
・Less bleeding due to vessel perforation
・Possibility of recanalization for CTO of no visible orifice of ATA , PTA , peroneal artery
What is benefit?
The loop could be advanced within the sub-intimal space without causing perforation.
Technical success rate 83.3%(55/66)
Vessel perforation 4.5 %(3/66)
Using 0.035 inch wire
J Endovasc Ther 2009;16:604–612.
Case 1
• 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
CTA
CTA
long CTO of left ATA and
peroneal artery 80F
long CTO of left ATA 80F
My strategy in this case
• Firstly I try to cross ATA occlusion using microcatheter
and 0.014 inch guidewire by antegrade approach.
• After recanalization I try to cross peroneal artery
occlusion using knuckle wire technique by retrograde
collateral approach.
• And finaly I planed to cross peroneal artery occlusion
using Rendezvous technique.
Recanalization of
left ATA occlusion
POBA for left ATA Rapid Cross 2.5/3mm x 21cm
(Medtronic Inc, Minneapolis, MN)
POBA for left ATA Rapid Cross 2.5/3mm x 21cm
POBA for left popliteal artery Rapid Cross 2.5/3mm x 21cm
Post POBA
Post POBA
Where is the orifice of PA ?
?
Collateral approach
Prominent Bta, GT 0.014 inch 45 angle
Collateral approach
Prominent Bta
GT 0.014 inch 45 angle
Rendezvous Technique
Retro : prominent Bta, GT 0.014 inch 45 angle
Ante : prominent NEO 135cm
Cross the lesion
POBA for peroneal artery
occlusion PTA balloon 3mm x 15cm
POBA for peroneal
artery occlusion PTA balloon 3mm x 15cm
Post Post PTA
Post
Post
ABI
Pre : 0.57
Post : 0.90
CASE 2
• Fale / 91 year-old
• C/C : Foot necrosis, Lt.3rd toe
(Fonatine classification: IV, Rutherford V)
• P/Hx : HT, HL – 10 years ago->Medication Tx
Cholecystitis – 4 years ago
Stenting for rt SFA occlusion, lt SFA stenosis, lt CIA
~EIA stenosis , PTA for rt BK lesion– 1 year ago
91 y.o. Female with foot necrosis
Lt.3rd toe
CTA
long CTO of left ATA 91 F
long CTO of left ATA 91 F
long CTO of left ATA 91 F
Retrograde approach
Prominent Bta 150cm
(Tokai Medical Products,
Aichi, JAPAN)
Regalia XS 1.0
(ASAHI INTECC,
Aichi, JAPAN)
GT wire 45 angle 180cm
(TERUMO CLINICAL
SUPPLY CO.,
Gifu, JAPAN)
Antegrade approach
Prominent NEO 135cm
(Tokai Medical Products,
Aichi, JAPAN)
Chevalier 14 floppy
(Johnson & Johnson K.K,
Paseo Padre Pkwy,
Fremont, CA USA)
Rendezvous Technique
Bellona 2.5mm x 12cm
(Medico's Hirata Inc.
3-4-3 Edobori, Nishi-ku, Osaka)
Bellona 2.5mm x 12cm
(Medico's Hirata Inc.
3-4-3 Edobori, Nishi-ku, Osaka)
SABER 3mm x 25cm
(Medtronic Inc, Minneapolis, MN)
SABER 3mm x 25cm
(Medtronic Inc, Minneapolis, MN)
Final angiography
Rendezvous point
Conclusion
Wire rendezvous and retrograde knuckle wire technique by collateral approach may be useful and safe for the long CTO of BTK lesion.
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