A novel lesion crossing technique: Balloon deployment using FORcible Manner (BADFORM) technique

Nakabayashi, Keisuke; Ando, Hiroshi; Kaneko, Nobuhito; Shiozaki, Manabu; Sunaga, Daisuke; Matsui, Atsushi; Tanaka, Kazuhiko; Shimizu, Mitsuru

doi:10.1002/ccd.27119

Cited by 18 publications

(12 citation statements)

References 11 publications

(9 reference statements)

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“…This device also could not pass the lesion; however, it modified the CTO entry-morphology (Figure 4(a)). After ELA ablation, the Caravel microcatheter (ASAHI Intecc) finally crossed the lesion using an antegrade approach with the BAlloon Deployment using FORcible Manner (BADFORM) technique [7] (Figure 4(b)), which enabled change of the wire from conventional the 0.014-inch wire to 0.009-inch RotaWire floppy (Boston Scientific) and RotaLink Plus 1.5mm burr ablation (Boston Scientific) (Figure 4(c)).…”

Section: Case Presentationmentioning

confidence: 99%

Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy

Nakabayashi

Hata

Kaneko

et al. 2019

Case Reports in Vascular Medicine

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Although endovascular therapy (EVT) is commonly used in treatment of peripheral artery disease (PAD), severely calcified lesions pose a challenge, in spite of the technical advancement. In this report, we discuss the case of a 74-year-old male with coronary artery disease and end-stage renal disease who presented at our institution with bilateral intermittent claudication. Angiography showed chronic total occlusion (CTO) of the right superficial femoral arteries (SFA). Because the bilateral external iliac arteries demonstrated moderate stenosis, we performed endovascular therapy on the right SFA-CTO using a contralateral approach. With the antegrade wire progressing into the subintimal space, direct distal-SFA puncture was performed and wire externalization was established. However, no devices (minimal balloon, microcatheter, or Crosser system) were able to pass the lesion in antegrade or retrograde manner, even though the child catheter support or needle cracking technique from outside/inside was applied. Therefore, we used a combination of an excimer laser and high-speed rotational atherectomy to overcome the severely calcified lesion. First, the excimer laser catheter (Turbo Elite 0.9 mm) ablated the entry to the CTO; however, it did not pass through completely. Thereafter, the thin microcatheter (Caravel) succeeded in crossing the CTO in an antegrade manner using the BAlloon Deployment using FORcible Manner (BADFORM) technique. After wire-exchange to the Rota-wire, rotational atherectomy (RotaLink Plus 1.5 mm) passed through the CTO. Subsequently, we could dilate the CTO lesion with a conventional balloon followed by bare metal stent deployment. The right ankle-brachial index of the patient improved from being unmeasurable to 0.79, and the intermittent claudication disappeared. This combination therapy, described as the “RASER” technique in coronary section, is accepted for reimbursement. However, these devices in EVT section are considered off-label use in Japan. Therefore, we have to refrain from frequent use of this strategy; however, this method provides an option for severely calcified lesions.

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Section: Case Presentationmentioning

confidence: 99%

Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy

Nakabayashi

Hata

Kaneko

et al. 2019

Case Reports in Vascular Medicine

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“…Nakabayashi et al reported the BADFORM technique for the treatment of BTK diseases. 5 This technique provides us with a strong backup force for lesion crossing. Considering this technique, after the guidewire externalization, the tail of the antegrade devices were fixed using a torque device.…”

Section: Discussionmentioning

confidence: 99%

“…Nakabayashi et al reported the BADFORM technique for the treatment of BTK diseases 5 . This technique provides us with a strong backup force for lesion crossing.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of the novel inner PIERCE technique for severely calcified below‐the‐knee occlusions in a patient with chronic limb‐threatening ischemia

Nakama¹,

Muraishi²,

Obunai³

et al. 2020

Cathet Cardio Intervent

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A severely calcified lesion is the most challenging entity in endovascular therapy (EVT) for below-the-knee (BTK) arteries. In this report, we introduce a challenging plaque modification technique known as the inner PIERCE technique. A 65-year-old man on hemodialysis with multiple toe ulcerations underwent an EVT for his BTK artery diseases. During EVT, the guidewire passed through the severely calcified posterior tibial and plantar arteries; however, the other devices could not pass through the lesion. Therefore, a novel inner PIERCE technique was performed. After guidewire externalization, an 18G 20 cm needle was advanced from the retrograde approach site, following the guidewire, for percutaneous transhepatic cholangiodrainage (PTCD). The PTCD needle was advanced into the severely calcified plaque using a rotational motion. Finally, the needle could pass through the lesion. After the inner PIERCE technique, an angioplasty was performed with a 2.5 mm balloon. The final angiography showed sufficient blood flow. After the EVT, complete wound healing was achieved in 4 months. This challenging technique may be an additional option for EVT to treat severely calcified BTK arteries.

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“…On the other hand, these labels readily suggest the potential and the inevitability of untoward events occurring during percutaneous revascularization of complex anatomy. The preceding report of 10 procedures did not result in significant complications despite its BADFORM name, however it was performed in only one center and only 10 patients needed this done over a span of 19 months .…”

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Butman

2017

Cathet Cardio Intervent

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A novel lesion crossing technique: Balloon deployment using FORcible Manner (BADFORM) technique

Abstract: The efficacy and safety of the BADFORM technique might be acceptable. © 2017 Wiley Periodicals, Inc.

Cited by 18 publications

References 11 publications

Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy

Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy

Efficacy of the novel inner PIERCE technique for severely calcified below‐the‐knee occlusions in a patient with chronic limb‐threatening ischemia

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