Percutaneous Axillary Artery Access for Lithoplasty of a Heavily Calcified Iliac Artery Chronic Total Occlusion
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PROVIDER: S-EPMC11307522 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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Project description:We present a case of calcified chronic total occlusion of the left anterior descending coronary artery with ambiguous cap at the bifurcation with a large diagonal branch, in which intravascular lithoplasty balloon was used to modify the calcified proximal cap and facilitate wire crossing. (Level of Difficulty: Advanced.).
| S-EPMC8743813 | biostudies-literature
Project description: Not available
| S-EPMC8084382 | biostudies-literature
Project description:BackgroundMesenteric ischaemia is often a manifestation of severe vascular disease involving the superior mesenteric artery (SMA). Endovascular revascularization is challenging in a chronic total occlusion (CTO) of SMA.Case presentationA-73-year-old male patient was referred to our hospital because of a 2-year history of post prandial abdominal angina. Computed tomography (CT) images revealed a heavily calcified CTO in the ostium of SMA and three-dimensional CT (3D-CT) detected pancreaticoduodenal arcade with filling from the celiac artery. Then, endovascular procedure was attempted; however, angiography did not show the collateral route suitable for transcollateral approach. As demonstrated on the CT, we were successful in passing a guidewire through the SMA-CTO via the celiac trunk transcollateral route. After pull-through of the guidewire, two balloon-expandable stents were deployed in the ostium of SMA. During 3 months after stent implantation, the patient had no further episodes of abdominal angina on dual-anti-platelet therapy.ConclusionWe demonstrate a case of a heavily calcified SMA occlusion successfully treated with endovascular stenting employing a transcollateral approach, guided by 3D-CT.
| S-EPMC8167909 | biostudies-literature
Project description:We herein report a case of percutaneous coronary intervention to a heavily calcified chronic total occlusion in the left anterior descending artery. Although we successfully performed retrograde wire crossing and wire externalization, we were unable to deliver small-sized balloon catheters in the lesion antegradely, even with strong back-up of wire externalization because of the heavy calcium mass. However, a balloon catheter was easily crossed retrogradely, and the lesion was successfully treated. Thus, retrograde balloon crossing might be a way to overcome device delivery failure in calcified lesions. <Learning objective: Dense calcium often prevents devices from passing through a chronic coronary total occlusion. In the present case, retrograde delivery through an epicardial collateral channel succeeded in balloon crossing, because changing the direction reversed the distribution of calcium for the passage.>.
| S-EPMC6451058 | biostudies-literature
Project description:Important breakthroughs have considerably improved the outcomes of the percutaneous treatment of valvular heart diseases during the last decades. However, calcium deposition and progressive calcification of the left-sided heart valves present a challenge with prognostic implications that have not been addressed until recently. In the case of native mitral stenosis with no surgical options, a compelling need for tackling heavily calcified valves has led to the development of novel debulking techniques and to the use of aortic balloon-expandable bioprosthesis in the mitral position. In this section of the special issue "Mitral Valve Disease: State of the Art", we will review standard approaches and indications for the treatment of native mitral stenosis; summarize these two innovative solutions and their evidence, describing both procedures in a "step-by-step" fashion; and briefly comment on future directions in this field.
| S-EPMC9657244 | biostudies-literature
Project description: Not available
| S-EPMC5998863 | biostudies-literature
Project description:Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA). Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded. Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach. Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.
| S-EPMC8141614 | biostudies-literature
Project description:Background: Percutaneous coronary intervention (PCI) of heavily calcified lesions remains challenging. This study examined whether calcified lesion preparation is better with an ablation-based than balloon-based technique. Methods and Results: Results of lesion preparations with and without atherectomy devices were compared in 121 patients undergoing optical coherence tomography (OCT)-guided PCI of heavily calcified lesions. Lesion preparation was performed with the ablation-based technique in 59 patients (atherectomy group) and with the balloon-based technique in 62 patients (balloon group). Lower grades of angiographic coronary dissections (National Heart, Lung, and Blood Institute [NHLBI] classification) occurred in the atherectomy than balloon group (atherectomy group: none, 33%; NHLBI A, 59%; B, 8%; C, 0%; D, 0%; balloon group: none, 1%; NHLBI A, 24%; B, 58%; C, 15%; D, 2%). On OCT, a large dissection was less common (49% vs. 90%; P<0.001) and calcium fractures were more frequent (75% vs. 18%; P<0.001) in the atherectomy than balloon group. In multivariable analyses, the ablation-based technique was associated with a lower grade of angiographic coronary dissection (adjusted odds ratio [aOR] 0.04; 95% confidence interval [CI] 0.01-0.12; P<0.001), a lower incidence of OCT-detected large dissection (aOR 0.09; 95% CI 0.03-0.30; P<0.001), and a higher incidence of OCT-detected calcium fracture (aOR 18.19; 95% CI 6.45-58.96; P<0.001). Conclusions: The ablation-based technique outperformed the balloon-based technique in the lesion preparation of heavily calcified lesions.
| S-EPMC9072102 | biostudies-literature
Project description:In this work, stenting in non-calcified and heavily calcified coronary arteries was quantified in terms of diameter-pressure relationships and load transfer from the balloon to the artery. The efficacy of post-dilation in non-calcified and heavily calcified coronary arteries was also characterized in terms of load sharing and the changes in tissue mechanics. Our results have shown that stent expansion exhibits a cylindrical shape in non-calcified lesions, while it exhibits a dog bone shape in heavily calcified lesions. Load-sharing analysis has shown that only a small portion of the pressure load (1.4 N, 0.8% of total pressure load) was transferred to the non-calcified lesion, while a large amount of the pressure load (19 N, 12%) was transferred to the heavily calcified lesion. In addition, the increasing inflation pressure (from 10 to 20 atm) can effectively increase the minimal lumen diameter (from 1.48 to 2.82 mm) of the heavily calcified lesion, the stress (from 1.5 to 8.4 MPa) and the strain energy in the calcification (1.77 mJ to 26.5 mJ), which are associated with the potential of calcification fracture. Results indicated that increasing inflation pressure can be an effective way to improve the stent expansion if a dog bone shape of the stenting profile is observed. Considering the risk of a balloon burst, our results support the design and application of the high-pressure balloon for post-dilation. This work also sheds some light on the stent design and choice of stent materials for improving the stent expansion at the dog bone region and mitigating stresses on arterial tissues.
| S-EPMC10558511 | biostudies-literature
Project description:IntroductionDuring stent grafting, managing the internal iliac artery (IIA) becomes a significant issue when an abdominal aortic aneurysm (AAA) is complicated by bilateral common iliac artery (CIA) aneurysms. The iliac branch system (IBS) has a defined length; therefore, the CIA should be sufficiently long. However, situations arise where the IBS must be used even in patients with a short CIA. A case of contralateral CIA occlusion due to deviation of the proximal iliac branched component of the IBS is reported.ReportA 73 year old man underwent stent grafting with inferior mesenteric artery coil embolisation and IBS for a 70 mm AAA and >30 mm bilateral CIA aneurysm. As standard procedure, the right iliac branched component and the internal iliac component were used. After removing the guidewire used for deploying the internal iliac component, the left 12 Fr Dryseal and guidewire were pulled down. The proximal end of the right iliac branched component deviated over the left CIA origin, resulting in CIA occlusion. As a solution, a 12 Fr Dryseal was inserted with a dilator and guidewire in the 16 Fr Dryseal from the left side, following which the tip of the 12 Fr Dryseal dilator was used to push the iliac branched component to create a gap. The guidewire was successfully inserted, and the surgery was subsequently completed as planned. The post-operative course of the patient was uneventful.ConclusionWhen deploying an iliac branched component in cases where the CIA is shorter than the length of the component, it is crucial to place the contralateral guidewire into the aorta before pulling down the contralateral sheath. The iliac branched component may follow the pull through wire and occlude the contralateral CIA. Furthermore, if the element occludes the contralateral CIA, it can be managed using this method.
| S-EPMC10336784 | biostudies-literature