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 subintimal 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, Ante : prominent NEO GT 0.014 inch 45 angle 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 PTA Post
Post
ABI Pre : 0.57 Post : 0.90 Post
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
91 y.o. Female with foot necrosis Lt.3 rd 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