Prediction of successful guidewire crossing of below-the-knee chronic total occlusions using a Japanese scoring system

Tan, Michinao; Ueshima, Daisuke; Urasawa, Kazushi; Hayakawa, Naoki; Dannoura, Yutaka; Itoh, Takahito; Kozuki, Amane; Shimooka, Yoshinori; Hayashi, Taichi; Sato, Yusuke

doi:10.1016/j.jvs.2021.01.059

Cited by 20 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The primary strategy for BTK CTO is generally to use antegrade wiring; however, a previous clinical studies reported a relatively high rate of antegrade guidewire crossing failure (Kokkinidis et al 2020 ; Tan et al 2021 ). Various retrograde approaches have improved the success rate of the procedure in BTK CTO; however, lesions with poor distal target vessels are extremely difficult to treat with retrograde approaches (Schmidt et al 2017 ).…”

Section: Discussionmentioning

confidence: 99%

An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Although endovascular therapy is used to treat chronic limb-threatening ischemia, long chronic total occlusion (CTO) is still challenging to treat. Especially in patients with poor run-off below-the-knee (BTK) arteries, it is difficult to perform a retrograde approach, and even guidewire passage may be difficult. Case presentation We treated two cases of chronic limb-threatening ischemia using our novel extreme antegrade guidewire crossing technique by AnteOwl WR intravascular ultrasound (IVUS)-guided parallel wiring to a BTK artery (EXCAVATOR technique). Case 1 was a 70-year-old man with ulceration of the right toe. The AnteOwl WR IVUS was intentionally advanced into the subintimal space of the posterior tibial artery, and the totally intraplaque route was advanced by IVUS-guided parallel wiring that was successfully passed from the lateral plantar aspect to the true lumen of the digital artery. Case 2 was a 76-year-old woman with rest pain and cyanosis of the right lower limb. Angiography showed total occlusion from the superficial femoral artery to BTK arteries. AnteOwl WR IVUS-guided parallel wiring was repeatedly performed until the distal true lumen of the peroneal artery was reached, and revascularization was successfully achieved via the antegrade approach alone. Conclusions With its excellent crossable performance, good image quality, and high navigational ability within the CTO, the AnteOwl WR can be used to pass parallel wiring into the distal true lumen for BTK CTO.

show abstract

Section: Discussionmentioning

confidence: 99%

An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…If an antegrade guidewire fails to advance into the distal true lumen, a retrograde approach might be considered to achieve successful revascularization. Previous studies have demonstrated the success rate of interventions for IP occlusive disease to be approximately 80%, even when using a retrograde approach 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have demonstrated the success rate of interventions forIP occlusive disease to be approximately 80%, even when using a retrograde approach. 1,2 Extra-vascular ultrasound (EVUS) is not only a major diagnostic tool for vascular diseases in general but is also very helpful as an imaging modality during recanalization procedures.…”

mentioning

confidence: 99%

Feasibility and impact of extra‐vascular ultrasound‐guided endovascular treatment for infrapopliteal artery occlusive disease

Tokuda

Oba

Kagase

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

Purpose: This study aimed to examine the feasibility and impact of extra-vascular ultrasound (EVUS)-guided intervention for infrapopliteal (IP) artery occlusive disease.Materials and Methods: A retrospective analysis was performed using data collected from patients who underwent endovascular treatment (EVT) for IP artery occlusive disease between January 2018 and December 2020 at our institution. A total of 63 consecutive de novoocclusive lesions were compared according to the recanalization method utilized. Propensity score matching analysis was performed to compare the clinical outcomes of the methods utilized. The prognostic value was analyzed based on the technical success rate, distal puncture rate, radiation exposure, amount of contrast media, postprocedural skin perfusion pressure (SPP), and procedural complication rate.Results: Eighteen matched pairs of patients were analyzed using propensity scorematched analysis. Radiation exposure was significantly lower in the EVUS-guided group than in the angio-guided group, with 135 and 287 mGy (p = 0.04) exposure on average, respectively. There were no significant differences between the two groups in terms of technical success rate, distal puncture rate, the amount of contrast media, postprocedural SPP, and procedural complication rate. Conclusion: EVUS-guided EVT for IP occlusive disease achieved a feasible technical success rate and significantly reduced radiation exposure. K E Y W O R D S extra-vascular ultrasound, infrapopliteal, occlusive disease 1 | INTRODUCTION Endovascular treatment (EVT) for infrapopliteal (IP) artery occlusive disease is sometimes technically challenging due to the small vessel diameter, long lesion length, and severe calcification. If an antegrade guidewire fails to advance into the distal true lumen, a retrograde approach might be considered to achieve successful revascularization. Previous studies have demonstrated the success rate of interventions forIP occlusive disease to be approximately 80%, even when using a retrograde approach. 1,2 Extra-vascular ultrasound (EVUS) is not only a major diagnostic tool for vascular diseases in general but is also very helpful as an imaging modality during recanalization procedures.

show abstract

“…The successful intervention for peripheral artery disease (PAD) is limited by complex lesion morphology including long CTOs and severe calcification (Ingle et al, 2002 ). Conventional PVI failed in up to 25% femoropopliteal CTOs (Scheinert et al, 2001 ), and lower success rate in below-the-knee artery (BKA) lesions due to the background of patients with critical limb-threatening ischemia was reported (Tan et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

The “Direct tip injection in occlusive lesions (DIOL)” fashion

et al. 2021

View full text Add to dashboard Cite

Background The successful intervention for peripheral artery disease is limited by complex chronic total occlusions (CTOs). During CTO wiring, without the use of intravascular or extravascular ultrasound, the guidewire position is unclear, except for calcified lesions showing the vessel path. To solve this problem, we propose a novel guidewire crossing with plaque modification method for complex occlusive lesions, named the “Direct tip Injection in Occlusive Lesions (DIOL)” fashion. Main text The “DIOL” fashion utilizes the hydraulic pressure of tip injection with a general contrast media through a microcatheter or an over-the-wire balloon catheter within CTOs. The purposes of this technique are 1) to visualize the “vessel road” of the occlusion from expanding a microchannel, subintimal, intramedial, and periadventitial space with contrast agent and 2) to modify plaques within CTO to advance CTO devices safely and easily. This technique creates dissections by hydraulic pressure. Antegrade-DIOL may create dissections which extend to and compress a distal lumen, especially in below-the-knee arteries. A gentle tip injection with smaller contrast volume (1–2 ml) should be used to confirm the tip position which is inside or outside of a vessel. On the other hand, retrograde-DIOL is used with a forceful tip injection of moderate contrast volume up to 5-ml to visualize vessel tracks and to modify the plaques to facilitate the crossing of CTO devices. Case-1 involved a severe claudicant due to right superficial femoral artery occlusion. After the conventional bidirectional subintimal procedure failed, we performed two times of retrograde-DIOL fashion, and the bidirectional subintimal planes were successfully connected. After two stents implantation, a sufficient flow was achieved without complications and restenosis for two years. Case-2 involved multiple wounds in the heel due to ischemia caused by posterior tibial arterial occlusion. After the conventional bidirectional approach failed, retrograde-DIOL was performed and retrograde guidewire successfully crossed the CTO, and direct blood flow to the wounds was obtained after balloon angioplasty. The wounds heeled four months after the procedure without reintervention. Conclusions The DIOL fashion is a useful and effective method to facilitate CTO treatment.

show abstract

Prediction of successful guidewire crossing of below-the-knee chronic total occlusions using a Japanese scoring system

Cited by 20 publications

References 19 publications

An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries

An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries

Feasibility and impact of extra‐vascular ultrasound‐guided endovascular treatment for infrapopliteal artery occlusive disease

The “Direct tip injection in occlusive lesions (DIOL)” fashion

Contact Info

Product

Resources

About