Endovascular Treatment of Severely Calcified Femoropopliteal Lesions Using the “Pave-and-Crack” Technique: Technical Description and 12-Month Results

Abstract

Despite severe lesion calcification, patients experienced high technical success and a safe and durable therapy at midterm follow-up with the femoropopliteal "pave-and-crack" technique.

The direct extravascular calcium interruption arterial procedure technique for heavily calcified vessels

“…Other plaque-cracking techniques have been reported by Kawarada et al 6 and Dias-Neto et al. 7 Karawarda et al 6 described the percutaneous intravascular cracking technique. In this technique, the stiff tail of a guidewire is used to crack severely calcified chronic total occlusion lesions.…”

“…In this technique, the stiff tail of a guidewire is used to crack severely calcified chronic total occlusion lesions. Dias-Neto et al 7 described a retrospective study of the “pave-and-crack” technique in which the lesion is first “cracked” in preparation for the “pave” with a stent. This technique is done by aggressive high-pressure or cutting balloon angioplasty and would therefore not be applicable if balloon crossing is not initially achieved.…”

A case of occluded femoropopliteal saphenous vein bypass with threatening limb ischemia treated with endovascular stent graft relining

“…9 On the other hand, percutaneous technique performs aggressive pre dilation and covers the artery to provide the opportunity to implant larger-diameter stent-graft for treating heavily calcified femoropopliteal lesions. 10 And like this method, we firstly cracked the vessel with a bigger size balloon, and then lined with stent-graft implantation. Although predilation with smaller balloon was considered just to deliver the stent-graft, afraid of underexpansion of the stent-graft, cracking-first then relining was conducted and threatened bleeding fortunately did not occurred.…”

Role of IVUS in the Endovascular Treatment of Calcified Femoropopliteal Lesions

“…6 Recently, a novel approach to achieve "gain following intentional vessel rupture" followed by the use of a covered stent, that is, the "pave and crack technique," was reported. 7 The authors discussed that if recoil occurs following deployment of a covered stent, an interwoven stent can be placed inside the covered stent. A primary patency rate of 78.6% was achieved despite having treated long lesions that were severely calcified [lesion length, 270 mm; PACCS grade 4 (bilateral >5 cm), 67%; total occlusion, 92%].…”