A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique
Abstract Background Although majority of cases with chronic total occlusion (CTO) in femoro-popliteal lesion were treated with antegrade approach only, some lesions require alternative approach due to its complexity. Bi-directional approach is useful on endovascular therapy (EVT) for CTO; however gu...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | CVIR Endovascular |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42155-023-00380-z |
| _version_ | 1797795469126008832 |
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| author | Hirokazu Miyashita Kazuki Tobita Syuhei Uchida Eiji Koyama Yusuke Tamaki Takayoshi Yamashita Shigeru Saito |
| author_facet | Hirokazu Miyashita Kazuki Tobita Syuhei Uchida Eiji Koyama Yusuke Tamaki Takayoshi Yamashita Shigeru Saito |
| author_sort | Hirokazu Miyashita |
| collection | DOAJ |
| description | Abstract Background Although majority of cases with chronic total occlusion (CTO) in femoro-popliteal lesion were treated with antegrade approach only, some lesions require alternative approach due to its complexity. Bi-directional approach is useful on endovascular therapy (EVT) for CTO; however guidewire passage through the lesion is impossible in some challenging cases. The present case shows a successful re-entry technique utilizing two snare catheters from an antegrade and retrograde access site (double snare piecing technique). Case presentation A 79-year-old woman with right leg intermittent claudication (Rutherford category IV), who had undergone unsuccessful EVT for popliteal CTO, required another EVT for the worsening symptom. Following the failed conventional crossing technique (wire knuckle technique, intravascular-ultrasound-guided wiring, and controlled antegrade and retrograde subintimal tracking technique), two snare catheters were placed and the snare loops were pierced by a puncture needle percutaneously. After an 0.014 wire was inserted into the needle, the needle was withdrawn. The wire was pulled from the retrograde side and was externalized. Then, the antegrade snare catheter was pulled and externalized, to make the wire across the lesion. After that, a microcatheter was advanced along the externalized wire from the retrograde side and cross the lesion. The wire was replaced with a new wire, which completely created pull-through system. After the hemostasis by balloon inflation and lesion preparation, this procedure was completed with an endoluminal-covered stent and two inter-woven stents. The re-entry site was covered by the inter-woven stent. Her symptoms improved after the procedure, and the lesion has not developed restenosis at 2-years follow-up. Conclusions This re-entry technique of puncturing two snare loops (double snare piercing technique) might be effective for achieving successful passage through challenging femoropopliteal CTO cases. |
| first_indexed | 2024-03-13T03:18:26Z |
| format | Article |
| id | doaj.art-ad6ac6103f024aa0a168127518bf74b3 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-03-13T03:18:26Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-ad6ac6103f024aa0a168127518bf74b32023-06-25T11:30:24ZengSpringerOpenCVIR Endovascular2520-89342023-06-01611510.1186/s42155-023-00380-zA case of chronic total occlusion in popliteal artery recanalized by double snare piercing techniqueHirokazu Miyashita0Kazuki Tobita1Syuhei Uchida2Eiji Koyama3Yusuke Tamaki4Takayoshi Yamashita5Shigeru Saito6Department of Cardiology, Heart Center, Shonan Kamakura General HospitalDepartment of Cardiology, Heart Center, Shonan Kamakura General HospitalDepartment of Cardiology, Heart Center, Shonan Kamakura General HospitalDepartment of Cardiology, Heart Center, Shonan Kamakura General HospitalDepartment of Cardiology, Heart Center, Shonan Kamakura General HospitalDepartment of Cardiology, Heart Center, Shonan Kamakura General HospitalDepartment of Cardiology, Heart Center, Shonan Kamakura General HospitalAbstract Background Although majority of cases with chronic total occlusion (CTO) in femoro-popliteal lesion were treated with antegrade approach only, some lesions require alternative approach due to its complexity. Bi-directional approach is useful on endovascular therapy (EVT) for CTO; however guidewire passage through the lesion is impossible in some challenging cases. The present case shows a successful re-entry technique utilizing two snare catheters from an antegrade and retrograde access site (double snare piecing technique). Case presentation A 79-year-old woman with right leg intermittent claudication (Rutherford category IV), who had undergone unsuccessful EVT for popliteal CTO, required another EVT for the worsening symptom. Following the failed conventional crossing technique (wire knuckle technique, intravascular-ultrasound-guided wiring, and controlled antegrade and retrograde subintimal tracking technique), two snare catheters were placed and the snare loops were pierced by a puncture needle percutaneously. After an 0.014 wire was inserted into the needle, the needle was withdrawn. The wire was pulled from the retrograde side and was externalized. Then, the antegrade snare catheter was pulled and externalized, to make the wire across the lesion. After that, a microcatheter was advanced along the externalized wire from the retrograde side and cross the lesion. The wire was replaced with a new wire, which completely created pull-through system. After the hemostasis by balloon inflation and lesion preparation, this procedure was completed with an endoluminal-covered stent and two inter-woven stents. The re-entry site was covered by the inter-woven stent. Her symptoms improved after the procedure, and the lesion has not developed restenosis at 2-years follow-up. Conclusions This re-entry technique of puncturing two snare loops (double snare piercing technique) might be effective for achieving successful passage through challenging femoropopliteal CTO cases.https://doi.org/10.1186/s42155-023-00380-zRetrograde approachChronic total occlusionPeripheral artery diseaseEndovascular therapy |
| spellingShingle | Hirokazu Miyashita Kazuki Tobita Syuhei Uchida Eiji Koyama Yusuke Tamaki Takayoshi Yamashita Shigeru Saito A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique CVIR Endovascular Retrograde approach Chronic total occlusion Peripheral artery disease Endovascular therapy |
| title | A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique |
| title_full | A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique |
| title_fullStr | A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique |
| title_full_unstemmed | A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique |
| title_short | A case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique |
| title_sort | case of chronic total occlusion in popliteal artery recanalized by double snare piercing technique |
| topic | Retrograde approach Chronic total occlusion Peripheral artery disease Endovascular therapy |
| url | https://doi.org/10.1186/s42155-023-00380-z |
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