Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach
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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? Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).
6 What is Wire rendezvous technique? Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).
7 What is Wire rendezvous technique?
8 What is Wire rendezvous technique?
9 What is Wire rendezvous technique? Advance antegrade microcatheter beyond CTO segment.
10 What is Wire rendezvous technique? Advance antegrade microcatheter beyond CTO segment.
11 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
12 What is benefit of retrograde knuckle wire technique? Journal of Clinical and Diagnostic Research Sep, Vol-10(9):
13 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
14 What is benefit? The loop could be advanced within the subintimal space without causing perforation. Technical success rate 83.3%(55/66) Vessel perforation 4.5 %(3/66) Using inch wire J Endovasc Ther 2009;16:
15 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
16 CTA
17 CTA
18 long CTO of left ATA and peroneal artery 80F
19 long CTO of left ATA 80F
20 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 finaly I planed to cross peroneal artery occlusion using Rendezvous technique.
21 Recanalization of left ATA occlusion
22 POBA for left ATA Rapid Cross 2.5/3mm x 21cm (Medtronic Inc, Minneapolis, MN)
23 POBA for left ATA Rapid Cross 2.5/3mm x 21cm
24 POBA for left popliteal artery Rapid Cross 2.5/3mm x 21cm
25 Post POBA
26 Post POBA
27 Where is the orifice of PA??
28
29 Collateral approach Prominent Bta, GT inch 45 angle
30 Collateral approach Prominent Bta GT inch 45 angle
31 Rendezvous Technique Retro : prominent Bta, Ante : prominent NEO GT inch 45 angle 135cm
32 Cross the lesion
33 POBA for peroneal artery occlusion PTA balloon 3mm x 15cm
34 POBA for peroneal artery occlusion PTA balloon 3mm x 15cm
35 Post PTA Post
36 Post
37 ABI Pre : 0.57 Post : 0.90 Post
38 CASE 2 Fale / 91 year-old C/C : Foot necrosis, Lt.3 rd 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
39 91 y.o. Female with foot necrosis Lt.3 rd toe
40 CTA
41
42 long CTO of left ATA 91 F
43 long CTO of left ATA 91 F
44 long CTO of left ATA 91 F
45
46
47
48 Retrograde approach Prominent Bta 150cm (Tokai Medical Products, Aichi, JAPAN)
49
50
51 Regalia XS 1.0 (ASAHI INTECC, Aichi, JAPAN)
52 GT wire 45 angle 180cm (TERUMO CLINICAL SUPPLY CO., Gifu, JAPAN)
53 Antegrade approach
54 Prominent NEO 135cm (Tokai Medical Products, Aichi, JAPAN) Chevalier 14 floppy (Johnson & Johnson K.K, Paseo Padre Pkwy, Fremont, CA USA)
55 Rendezvous Technique
56
57
58
59
60
61
62
63 Bellona 2.5mm x 12cm (Medico's Hirata Inc Edobori, Nishi-ku, Osaka)
64 Bellona 2.5mm x 12cm (Medico's Hirata Inc Edobori, Nishi-ku, Osaka)
65 SABER 3mm x 25cm (Medtronic Inc, Minneapolis, MN)
66 SABER 3mm x 25cm (Medtronic Inc, Minneapolis, MN)
67 Final angiography
68
69 Rendezvous point
70
71
72
73
74
75 Conclusion Wire rendezvous and retrograde knuckle wire technique by collateral approach may be useful and safe for the long CTO of BTK lesion.
76 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
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