Parallel Wiring Using a Single Intravascular Ultrasound Catheter with Double Rapid Exchange Lumens Technique for Chronic Total Occlusions in Peripheral Artery Disease

Abstract

Purpose: To describe a parallel wiring using a single intravascular ultrasound catheter with double rapid exchange lumens (PASSABLE) technique for peripheral CTOs. Technique: The technique is demonstrated in a 73-year-old patient with CTOs of the superficial femoral and popliteal artery. Intravascular ultrasound (IVUS) examination revealed the first guidewire was advanced to the intramedial space of the popliteal artery. Following insertion of the first guidewire into only the distal rapid exchange lumen of the IVUS catheter and a second guidewire into the proximal rapid exchange lumen, a guidewire torquer was passed over it and tightened close to an exit port of the proximal rapid exchange lumen to prevent it from exiting an entry port while advancing the IVUS catheter. The IVUS catheter was advanced to the intraplaque region using only the distal rapid exchange lumen and the second guidewire was then advanced to the intraplaque region under IVUS guidance. The IVUS-guided wiring using the second guidewire on both the distal and proximal rapid exchange lumen was continued and resulted in a successful guidewire crossing into the distal true lumen. Conclusion: This novel technique may prove beneficial in enabling operators to perform IVUS-guided parallel wiring more easily and efficiently.

A novel initial wiring technique for chronic total occlusion of the superficial femoral artery using the structural features of a polymer jacket guidewire

“…Even if the conventional wiring is the most frequently used wiring technique, avoiding the wire advancement into the subintimal space is difficult. To overcome the difficulty of recanalization through the subintimal space, retrograde wiring, trans-collateral wiring, IVUS-guided wiring, and the use of a true lumen reentry device have been reported (Schmidt et al 2012;Urasawa et al, 2014;Kitrou et al 2015;Tan et al 2017;Hayakawa et al 2021;Tan et al 2022). Although exceptional skills and additional devices are needed, these techniques are quite effective in crossing the wire into CTO lesions.…”