Introduction: Chronic limb-threatening ischemia (CLTI) is a syndrome that represents the end-stage of peripheral artery disease (PAD) that increased the risk of major amputation and cardiovascular events. The initial treatment for CLTI may significantly impact the risk of major amputation or death. Objective: This case report aims to describe limb preservation with balloon angioplasty in a Critical Limb Ischemia patient. Case Presentation: A hypertensive 72-years old female complained of left leg pain followed by a wound on her left toe four months ago. Her toe was amputated, but the wound persists. On physical examination, the pulsation was diminished in her left foot. Duplex ultrasound showed monophasic spectral doppler from left popliteal artery to distal left anterior tibial artery (ATA) and distal posterior tibial artery (PTA). CT-Angiography showed short total occlusion (2cm) at the distal left Superficial Femoral artery (SFA), multiple stenoses with maximal 90% stenosis at the left ATA, and chronic total occlusion at the proximal-mid left posterior tibial artery (PTA). She was diagnosed with CLTI left inferior extremity Fontaine IV Rutherford 5. The angiography result was similar to the CT-angiography result. The patient was successfully treated with plain balloon angioplasty from distal left SFA to distal left ATA and drug-coated balloon angioplasty from the distal left SFA to the popliteal artery. Her wound was also consulted to the surgical department. Conclusion: Appropriate revascularization is fundamental to limb preservation. We successfully perform endovas- cular strategy with TIMI flow 3 from left SFA to distal left ATA and distal PTA in our patient, but we still need further holistic CLTI management.

ST segment elevation myocardial infarction (STEMI) caused by atherosclerotic vulnerable plaque rupture or plaque erosion, resulting in activation of the coagulation cascade. It causes a temporal sequence known as the “ischemic cascade,” which first involves the metabolic process, the diastolic dysfunction, and then systolic dysfunction. Diastolic dysfunction in STEMI patient is an independent predictor for long-term outcome. Rapid and early restoration of blood flow is critical to ensure cell recovery and prevent additional damage.

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