Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous
Abstract Background Severe calcification often prevents device passage and balloon expansion in cases of lower extremity artery disease. To address this limitation, we introduced a novel calcium modification technique called Rendezvous-PIERCE (R-PIERCE). Methods A needle was inserted in a retrograde...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-03-01
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| Series: | CVIR Endovascular |
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| Online Access: | https://doi.org/10.1186/s42155-024-00445-7 |
| _version_ | 1797259031933353984 |
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| author | Takuya Haraguchi Masanaga Tsujimoto Yoshifumi Kashima Katsuhiko Sato Tsutomu Fujita |
| author_facet | Takuya Haraguchi Masanaga Tsujimoto Yoshifumi Kashima Katsuhiko Sato Tsutomu Fujita |
| author_sort | Takuya Haraguchi |
| collection | DOAJ |
| description | Abstract Background Severe calcification often prevents device passage and balloon expansion in cases of lower extremity artery disease. To address this limitation, we introduced a novel calcium modification technique called Rendezvous-PIERCE (R-PIERCE). Methods A needle was inserted in a retrograde manner and advanced to touch the tip of an antegrade guidewire within the lesion. Then, the guidewire was advanced into the lumen of the needle to achieve partial guidewire externalization, also known as needle rendezvous. The needle was then introduced over the externalized guidewire under wire tension and repeatedly rotated and advanced across the lesion to modify calcified intimal plaques. Notably, this technique can be applied in the opposite direction. Results Case 1 involved a 68-year-old male with a calcified occlusion of the anterior tibial artery. An antegrade guidewire reached the midpoint of the occlusion; however, microcatheters and balloons could not pass through the proximal calcification. Therefore, R-PIERCE was used to modify uncrossable lesions. An antegrade 2.5-mm balloon crossed and dilated the lesion, achieving hemostasis at the needle insertion site. The antegrade guidewire successfully crossed the entire lesion and was dilated by the 2.5-mm balloon. Final angiography demonstrated successful flow. In Case 2, an 80-year-old male had a calcified femoropopliteal occlusion. An antegrade guidewire was advanced into the distal superficial femoral artery (SFA); however, no device could follow it. R-PIERCE was performed to modify the calcification from the distal to the medial SFA. The antegrade balloon successfully crossed and dilated obstructed lesions. Furthermore, the antegrade guidewire crossed the entire lesion, and the antegrade balloon was dilated. Final angiography revealed a successful flow without complications. Conclusions R-PIERCE is useful for modifying complex calcified lesions during the wiring of occlusive lesions. |
| first_indexed | 2024-04-24T23:02:58Z |
| format | Article |
| id | doaj.art-c3fbd0c03534475f9224ec0c0dcc68be |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-04-24T23:02:58Z |
| publishDate | 2024-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-c3fbd0c03534475f9224ec0c0dcc68be2024-03-17T12:39:31ZengSpringerOpenCVIR Endovascular2520-89342024-03-01711510.1186/s42155-024-00445-7Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvousTakuya Haraguchi0Masanaga Tsujimoto1Yoshifumi Kashima2Katsuhiko Sato3Tsutomu Fujita4Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular ClinicDepartment of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular ClinicDepartment of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular ClinicDepartment of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular ClinicDepartment of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular ClinicAbstract Background Severe calcification often prevents device passage and balloon expansion in cases of lower extremity artery disease. To address this limitation, we introduced a novel calcium modification technique called Rendezvous-PIERCE (R-PIERCE). Methods A needle was inserted in a retrograde manner and advanced to touch the tip of an antegrade guidewire within the lesion. Then, the guidewire was advanced into the lumen of the needle to achieve partial guidewire externalization, also known as needle rendezvous. The needle was then introduced over the externalized guidewire under wire tension and repeatedly rotated and advanced across the lesion to modify calcified intimal plaques. Notably, this technique can be applied in the opposite direction. Results Case 1 involved a 68-year-old male with a calcified occlusion of the anterior tibial artery. An antegrade guidewire reached the midpoint of the occlusion; however, microcatheters and balloons could not pass through the proximal calcification. Therefore, R-PIERCE was used to modify uncrossable lesions. An antegrade 2.5-mm balloon crossed and dilated the lesion, achieving hemostasis at the needle insertion site. The antegrade guidewire successfully crossed the entire lesion and was dilated by the 2.5-mm balloon. Final angiography demonstrated successful flow. In Case 2, an 80-year-old male had a calcified femoropopliteal occlusion. An antegrade guidewire was advanced into the distal superficial femoral artery (SFA); however, no device could follow it. R-PIERCE was performed to modify the calcification from the distal to the medial SFA. The antegrade balloon successfully crossed and dilated obstructed lesions. Furthermore, the antegrade guidewire crossed the entire lesion, and the antegrade balloon was dilated. Final angiography revealed a successful flow without complications. Conclusions R-PIERCE is useful for modifying complex calcified lesions during the wiring of occlusive lesions.https://doi.org/10.1186/s42155-024-00445-7Calcified lesionChronic total occlusionEndovascular therapyPeripheral artery disease |
| spellingShingle | Takuya Haraguchi Masanaga Tsujimoto Yoshifumi Kashima Katsuhiko Sato Tsutomu Fujita Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous CVIR Endovascular Calcified lesion Chronic total occlusion Endovascular therapy Peripheral artery disease |
| title | Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous |
| title_full | Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous |
| title_fullStr | Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous |
| title_full_unstemmed | Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous |
| title_short | Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous |
| title_sort | rendezvous pierce technique establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous |
| topic | Calcified lesion Chronic total occlusion Endovascular therapy Peripheral artery disease |
| url | https://doi.org/10.1186/s42155-024-00445-7 |
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