Impact of Aggressive Endovascular Recanalization Techniques on Success Rate in Chronic Total Arterial Occlusions (CTOs)

Sharafuddin, Melhem J.; Hoballah, Jamal J.; Kresowik, Timothy F.; Nicholson, Rachael; Sharp, William J.

doi:10.1177/1538574410370375

Cited by 12 publications

(7 citation statements)

References 57 publications

(68 reference statements)

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“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], with a mean overall procedure duration from ENABLER-P catheter anchoring to withdrawal of 14.7 minutes (range 1-44).…”

Section: Resultsmentioning

confidence: 99%

“…The main reasons for failure of CTO recanalization are the inability to cross the occlusion with a guidewire or the inability to re-enter the true lumen following subintimal tracking. 9,10 Advancements in imaging technologies have improved CTO crossing techniques, rendering them more effective in some complex lesions. Long or heavily calcified lesions are often treated with subintimal angioplasty, a technique that has revolutionized the treatment of above-the-knee arterial occlusions.…”

Section: ¤ ¤mentioning

confidence: 99%

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Recanalization of Femoropopliteal Chronic Total Occlusions Using the ENABLER-P Balloon Catheter System

Zeller

Kambara

Moreira

et al. 2012

Journal of Endovascular Therapy

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Section: Resultsmentioning

confidence: 99%

Section: ¤ ¤mentioning

confidence: 99%

Recanalization of Femoropopliteal Chronic Total Occlusions Using the ENABLER-P Balloon Catheter System

Zeller

Kambara

Moreira

et al. 2012

Journal of Endovascular Therapy

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“…Our approach is also less risky than a "pure" retrograde approach from the ipsilateral femoral as it is easier to confirm position in the true lumen in the Aorta and can lower the risk of perforation or dissection at the distal Aorta [10] without requiring complicated imaging guided reentry devices [8]. This approach is also less aggressive and worth attempting before trying more radical methods such as stiff end of wires and sharp needles as described in other reports [7]. There are additional factors that may have contributed to the success in the described cases.…”

Section: Discussionmentioning

confidence: 95%

“…The most common reason for failure of an endovascular approach in CTOs is inability to cross the CTO with a guidewire [7]. In cases with a retrograde femoral approach from the ipsilateral side can be complicated by difficulty in obtaining femoral access and if successful access is obtained, there can be difficulty in crossing the distal cap and use of re-entry devices is fraught with the risk of causing perforation especially with unpredictable level of reentry into the Aorta.…”

Section: Introductionmentioning

confidence: 99%

Novel Use of the “Contra Catheter” (CC) In Proximal Iliac Artery Chronic Total Occlusion (PICTO) Recanalization

2016

JCCR

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Proximal Iliac Artery chronic total occlusion (PICTO) interventions via contralateral femoral approach are challenging due to the lack of catheter support. In patients with the appropriate anatomy, the Contra Catheter (CC) grasps the aortic bifurcation like a clip and can facilitate crossing of the occlusion. We describe three cases with PICTOs in which the CC was able to provide adequate support with a contralateral femoral approach and obviate the need for an arm approach.

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“…9) CTO lesions can result in a worsening of the initial procedural success rate. 10) Because of difficulty in penetrating CTO lesions with marked calcification, special devices are required in some cases. 11) Even if the initial procedure is successful, CTO is recognized as one of the factors affecting in-stent restenosis (ISR) and the long-term outcome of EVT for CTO lesions in SFA is one of the remaining issues.…”

Section: Discussionmentioning

confidence: 99%

Pathology of Neointimal Calcification in Very Late Restenosis After Bare Metal Stent Implantation for Superficial Femoral Artery

et al. 2017

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SummaryA 60-year-old man, who had claudication in his right limb due to total occlusion of the right superficial femoral artery, received bare metal stents. Although the bare metal stents in the superficial femoral artery did not show restenosis 5 years after stent implantation, angiography revealed significant in-stent restenosis when he developed right critical limb ischemia at 8 years post implantation. Ballooning for in-stent lesions did not result in full expansion. His right limb was amputated above the knee due to progressive limb ischemia. In the pathological findings in the superficial femoral artery, marked calcification was observed in the entire circumference of the luminal surface of the neointima. However, lipid core formation was not identified in the neointima. Although several cracks following balloon angioplasty were observed at the superficial calcified layers, injury to neointimal tissue such as compression was not observed. The neointima exhibited heavy calcification in the very late phase of in-stent restenosis after bare metal stent implantation in superficial femoral artery. Therefore, balloon angioplasty in the very late phase of in-stent restenosis potentially results in underexpansion. (Int Heart J 2017; 58: 641-644) Key words: Endovascular therapy, Neoatherosclerosis, Peripheral artery E ndovascular therapy (EVT) for superficial femoral artery (SFA) stenosis has become a common treatment. 1)When preforming EVT for SFA lesions, bare metal stents (BMSs) are often implanted.2) The efficacy of primary stenting using self-expanding nitinol stents has been widely reported and the clinical outcomes of EVT for SFA lesions have been improved by the use of self-expanding nitinol stents. 3)Even if early restenosis within 1 year can be prevented, there is still the potential for restenosis in the late and very late phases after BMS implantation. However, late and very late vascular responses have not been evaluated. Here, we report a case of major amputation with very late restenosis after BMS implantation for SFA and also present the pathological findings. Case ReportA 60-year-old man, who was on hemodialysis due to diabetes and had a past history of angina and cerebral infarction, had claudication of Rutherford class 3 in his right lower limb due to peripheral artery disease. Angiography showed chronic total occlusion (CTO) of the right SFA ( Figure 1A). Because his symptom continued at the same level despite appropriate medical therapy, he underwent EVT for right SFA. Two BMSs (Zilver [Cook Medical, Bloomington, Indiana] 6.0 mm*60 mm stent in the proximal lesion and Zilver 6.0 mm*80 mm stent in the distal lesion) were implanted ( Figure 1B). After performing EVT, his ankle-brachial index improved from 0.32 to 0.89 and his symptom disappeared. Five years after BMS implantation, his symptom recurred due to a new and short de novo stenosis that was situated at a proximal site in the right SFA segment that received a BMS. Therefore, he underwent plain old balloon angioplasty (POBA) for the de n...

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Impact of Aggressive Endovascular Recanalization Techniques on Success Rate in Chronic Total Arterial Occlusions (CTOs)

Abstract: Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.

Cited by 12 publications

References 57 publications

Recanalization of Femoropopliteal Chronic Total Occlusions Using the ENABLER-P Balloon Catheter System

Recanalization of Femoropopliteal Chronic Total Occlusions Using the ENABLER-P Balloon Catheter System

Novel Use of the “Contra Catheter” (CC) In Proximal Iliac Artery Chronic Total Occlusion (PICTO) Recanalization

Pathology of Neointimal Calcification in Very Late Restenosis After Bare Metal Stent Implantation for Superficial Femoral Artery

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