A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries
PURPOSEEndovascular therapy has recently become acceptable for the reconstruction of below-the-knee (BTK) and below-the-ankle (BTA) arterial lesions. However, we have sometimes experienced BTK or BTA lesions with calcifications that are too severe for balloon catheters to cross or expand despite suc...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Galenos Publishing House
2021-05-01
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| Series: | Diagnostic and Interventional Radiology |
| Online Access: |
http://www.dirjournal.org/archives/archive-detail/article-preview/a-novel-technique-of-percutaneous-intraluminal-cra/54356
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| _version_ | 1797691386914406400 |
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| author | Tatsuro Takei Akira Miyamoto Tomonari Takagi Yasutaka Yamauchi |
| author_facet | Tatsuro Takei Akira Miyamoto Tomonari Takagi Yasutaka Yamauchi |
| author_sort | Tatsuro Takei |
| collection | DOAJ |
| description | PURPOSEEndovascular therapy has recently become acceptable for the reconstruction of below-the-knee (BTK) and below-the-ankle (BTA) arterial lesions. However, we have sometimes experienced BTK or BTA lesions with calcifications that are too severe for balloon catheters to cross or expand despite successful guidewire passage. In this study, we assessed the feasibility and safety of the novel inner PIERCE technique for breaking down the calcium burden of BTK and BTA arterial lesions.METHODSWe retrospectively reviewed the records of patients who had undergone endovascular therapy between August 2018 and December 2019. The inner PIERCE technique was performed in those cases where low-profile balloon catheters were unable to pass through the target lesions or balloon indentation did not disappear beyond the rated burst pressure. An externalized guidewire system was established in 8 cases via bidirectional approaches, and a 20-gauge needle was directly inserted through the guidewires from the distal puncture site. In 10 cases of successful antegrade wiring, the tibial or pedal arteries distal to the lesion site were punctured for a retrograde guidewire approach to the lesion. The needle was slowly rotated and advanced across the lesion.RESULTSWe found that all lesions were severely calcified and 83.3% had chronic total occlusion. The inner PIERCE procedure allowed successful passage of the needle and subsequent low-profile balloon catheters in all cases. Optimal balloon dilatation was achieved in 94.4% of the cases using this technique. No procedure-related adverse events were observed.CONCLUSIONThe novel inner PIERCE technique is a safe and feasible method for disrupting calcified BTK and BTA lesions. |
| first_indexed | 2024-03-12T02:12:34Z |
| format | Article |
| id | doaj.art-d66f11ccae8741ecb1721fe45d29dbc3 |
| institution | Directory Open Access Journal |
| issn | 1305-3825 1305-3612 |
| language | English |
| last_indexed | 2024-03-12T02:12:34Z |
| publishDate | 2021-05-01 |
| publisher | Galenos Publishing House |
| record_format | Article |
| series | Diagnostic and Interventional Radiology |
| spelling | doaj.art-d66f11ccae8741ecb1721fe45d29dbc32023-09-06T12:21:06ZengGalenos Publishing HouseDiagnostic and Interventional Radiology1305-38251305-36122021-05-0127341341710.5152/dir.2021.2067513049054A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteriesTatsuro Takei0Akira Miyamoto1Tomonari Takagi2Yasutaka Yamauchi3 Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan PURPOSEEndovascular therapy has recently become acceptable for the reconstruction of below-the-knee (BTK) and below-the-ankle (BTA) arterial lesions. However, we have sometimes experienced BTK or BTA lesions with calcifications that are too severe for balloon catheters to cross or expand despite successful guidewire passage. In this study, we assessed the feasibility and safety of the novel inner PIERCE technique for breaking down the calcium burden of BTK and BTA arterial lesions.METHODSWe retrospectively reviewed the records of patients who had undergone endovascular therapy between August 2018 and December 2019. The inner PIERCE technique was performed in those cases where low-profile balloon catheters were unable to pass through the target lesions or balloon indentation did not disappear beyond the rated burst pressure. An externalized guidewire system was established in 8 cases via bidirectional approaches, and a 20-gauge needle was directly inserted through the guidewires from the distal puncture site. In 10 cases of successful antegrade wiring, the tibial or pedal arteries distal to the lesion site were punctured for a retrograde guidewire approach to the lesion. The needle was slowly rotated and advanced across the lesion.RESULTSWe found that all lesions were severely calcified and 83.3% had chronic total occlusion. The inner PIERCE procedure allowed successful passage of the needle and subsequent low-profile balloon catheters in all cases. Optimal balloon dilatation was achieved in 94.4% of the cases using this technique. No procedure-related adverse events were observed.CONCLUSIONThe novel inner PIERCE technique is a safe and feasible method for disrupting calcified BTK and BTA lesions. http://www.dirjournal.org/archives/archive-detail/article-preview/a-novel-technique-of-percutaneous-intraluminal-cra/54356 |
| spellingShingle | Tatsuro Takei Akira Miyamoto Tomonari Takagi Yasutaka Yamauchi A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries Diagnostic and Interventional Radiology |
| title | A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries |
| title_full | A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries |
| title_fullStr | A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries |
| title_full_unstemmed | A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries |
| title_short | A novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below-the-knee and below-the-ankle arteries |
| title_sort | novel technique of percutaneous intraluminal cracking using a puncture needle for severe calcified lesions of below the knee and below the ankle arteries |
| url |
http://www.dirjournal.org/archives/archive-detail/article-preview/a-novel-technique-of-percutaneous-intraluminal-cra/54356
|
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