Efficacy of metal tip catheter for chronic total occlusion lesions in peripheral arterial disease

Cardiovascular Intervention and Therapeutics - Tập 27 - Trang 19-23 - 2011
Minoru Ihara1, Tsugiyoshi Yamazaki1, Masaharu Kudo1, Osamu Murai1, Yoshiaki Tsukamoto1
1Department of Cardiology, Cardiovascular Center, Kawasaki Saiwai Hospital, Kawasaki, Japan

Tóm tắt

We performed several techniques for chronic total occlusion (CTO) lesions in peripheral arterial disease (PAD). We evaluated the cases using the metal tip catheter (MT). We performed peripheral endovascular therapy (EVT) using MT in 31 cases 32 lesions of PAD from March 2007 to March 2011. Twenty-nine cases were CTO lesions using MT for back up of guidewire or MT alone in order to penetrate like a bougie with the blunt tip of MT. Two cases were acute arterial thrombosis for thrombectomy. Seven cases were CTO of the iliac artery (IA) and 25 cases were of the femoral artery (FA). Seven cases were in-stent restenosis. All 7 cases of IA were successfully treated with the initial techniques. We were unable to penetrate by MT(MT-) in 7 cases of FA, and in 2 cases out of the 7, we were even unable to cross the guidewire. Mean lesion length was 80 ± 42 mm in IA and 188 ± 88 mm in SFA. Among them, MT- was 164 ± 67 mm with no significant differences. Procedure time of EVT for CTO using MT was significantly shorter than other strategies. We had no complications such as perforation by using MT. MT provides high initial success rate by spectacular penetration performance and pushability. MT is a safe and effective device for CTO in PAD.

Tài liệu tham khảo

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;45(1):S5–67. Inoue N. Femoral-popliteal artery above-knee revascularization. In: Selection. TOPIC 2009; 2009. p. 20–3. Urasawa K. Peripheral Intervention for chronic total occlusion lesions of the legs. In: TOPIC 2009; 2009. p. 24–9. Hirano K. Percutaneous transluminal peripheral intervention for the superficial artery and below the knee. In: TOPIC 2007; 2007. p. 274–80. Spinosa DJ, Leung DA, Harthun NL, Cage DL, Fritz Angle J, Hagspiel KD, et al. Simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. J Vasc Interv Radiol. 2003;14:1449–54. Yilmaz S, Sindel T, Luleci E. Bilateral transpopliteal approach for treatment of complex SFA and iliac occlusions. Eur Radiol. 2002;12:911–4. Nadal LL, Cynamon J, Lipsitz EC, Bolia A. Subintimal angioplasty for chronic arterial occlusions. Tech Vasc Interv Radiol. 2004;7:16–22. Hausegger KA, Georgieva B, Portugaller H, Tauss J, Stark G. The outback catheter. A new device for true lumen re-entry after dissection during recanalization of arterial occlusions. Cardiovasc Interv Radiol. 2004;27:26–30. Riddick J, Cates C, Niazi K, Cates C. True lumen re-entry catheter availability improves procedural success in endovascular intervention of peripheral total occlusions. J Am Coll Cardiol. 2007;49:29B. Jacobs DL, Motaganahalli RL, Cox DE, Wittgen CM, Peterson GJ. True lumen re-entry devices facilitate subintimal angioplasty and stenting of total chronic occlusions. J Vasc Surg. 2006;43:1291–6. Ulrich B, Sebastian S, Uwe S, Aljoscha R, Christian M, Elias N, et al. Recanalization of chronic occlusions of the superficial femoral artery using the outback re-entry catheter. Catheter Cardiovasc Interv. 2009;15:934–8. Husmann M, Federer J, Keo HH, Schmidli J, Kickuth R, Baumgartner I, et al. Bailout revascularization of chronic femoral artery occlusions with the new outback catheter following failed conventional endovascular intervention. J Endovasc Ther. 2009;16(2):213–4. Bozlar U, Shih MC, Harthun NL, Hagspiel KD. Outback catheter-assisted simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion. Clin Imaging. 2008;32(3):236–40. Al-Ameri H, Shin V, Mayeda GS, Burstein S, Matthews RV, Kloner RA, et al. Peripheral chronic total occlusions treated with subintimal angioplasty and a true lumen re-entry device. J Invasive Cardiol. 2009;21(9):468–72. Kandarpa K. Chapter 19 Lower extremity arterial revascularization, Section III. Vascular Interventions. Peripheral Vasc Interv. 2007;338.