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Intravascular Ultrasound Findings after Successful Guidewire Passage With a Retrograde Narrowing Looped Wire Technique.

ABSTRACT:

SUBMITTER: Nakama T

PROVIDER: S-EPMC8077234 | biostudies-literature |

REPOSITORIES: biostudies-literature

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A case report on intravascular lithotripsy to facilitate retrograde wire passage from the subintimal to the luminal space in a calcified chronic total occlusion

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First successful implementation of subintimal transcatheter withdrawal technique in intravascular ultrasound-guided tip detection antegrade dissection and reentry: a case report.

Project description:BackgroundAntegrade dissection and reentry (ADR) is an effective technique for wire passage in chronic total occlusion (CTO), and in recent years, the effectiveness of intravascular ultrasound (IVUS)-guided tip detection (TD)-ADR has been reported. However, the expansion of the subintimal space serves as a significant obstacle to the success of ADR, posing a limitation to the procedure.Case summaryWe present the first case of using IVUS-guided TD-ADR with the subintimal transcatheter withdrawal (STRAW) technique. The patient was a 68-year-old Asian female with effort angina pectoris and a CTO in the middle section of the right coronary artery (RCA). Two previous attempts at percutaneous coronary intervention (PCI) for the RCA at another hospital were unsuccessful. During the third attempt PCI, the antegrade wire migrated into the subintimal space. To address this, we performed IVUS-guided TD-ADR using the Conquest Pro 12 Sharpened Tip (CP12ST; Asahi Intecc, Aichi, Japan) wire. However, due to the expansion of the subintimal space, we were unable to puncture the true lumen. To reduce the subintimal space, we employed the STRAW technique, which allowed successful puncture of the true lumen using the CP12ST wire. Finally, stenting was performed, resulting in satisfactory antegrade blood flow.DiscussionIntravascular ultrasound-guided TD provides accurate guidance for puncturing in ADR procedures, but the expansion of the subintimal space remains a significant challenge. The STRAW technique offers a solution by reducing the subintimal space and enabling successful puncture of the true lumen during IVUS-guided TD-ADR.

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Successful Percutaneous Coronary Intervention Using Intravascular Ultrasound-Guided Rewiring Technique in a Case of Spontaneous Coronary Artery Dissection Involving Left Main Bifurcation.

Project description:We herein describe a 49-year-old woman without significant cardiovascular risk factors who was transferred to our hospital with sudden onset of chest pain. The patient was diagnosed with non-ST-elevation acute myocardial infarction, and coronary angiography revealed a dissection at the proximal site of the left anterior descending artery (LAD) extending from the left main trunk (LMT) suggestive of spontaneous coronary artery dissection (SCAD). Because coronary flow was impaired after contrast injection and the patient had chest pain with ST elevation, urgent percutaneous coronary intervention was performed. The first guide wire was initially introduced from the LMT to the distal LAD, but intravascular ultrasound (IVUS) imaging revealed that the guide wire had passed through the true lumen of the left coronary artery ostium, false lumen at the ostium of the left circumflex artery, and true lumen of the distal LAD. We then reinserted another guide wire using an IVUS-guided rewiring technique from the true lumen of the LMT to the distal LAD. Finally, a drug-eluting stent was deployed to cover the dissected segment, and final coronary angiography revealed acceptable results with a patent left circumflex artery. This case report highlights that physicians should consider SCAD among the differential diagnoses in patients presenting with acute coronary syndrome, particularly in young women. In the present case, IVUS played a pivotal role in not only detecting the arterial dissection but also correctly introducing the guide wire into the true lumen.

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Successful retrieval of fractured pressure wire tip (FFR) by hybrid technique.

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Case report: intravascular ultrasound sonography-guided re-entry technique in crushed stent.

Project description:Background:Stent thrombosis (ST) is a rare, but potentially fatal complication. Procedural problems, such as stent under-dimension/under-expansion or dual antiplatelet drug resistance may result into ST. These conditions are more frequent during primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Case summary:A 60-year-old male patient presented to our hospital with an inferior STEMI. In the emergency department, a dual antiplatelet therapy was administered with ticagrelor 180?mg and aspirin 250?mg IV. During the observation, the patient experienced a ventricular fibrillation. Urgent coronary angiography showed an occlusion of the proximal right coronary artery. Thrombus aspiration was performed followed by implantation of one drug-eluting stent. After 45?min early ST occurred and was treated by immediate thrombus aspiration and post-dilatation. Intravascular ultrasound sonography (IVUS) showed severe strut malapposition due to a partial crush after post-dilatation. Since it was not possible to directly insert the first guidewire in the stent lumen, the IVUS probe was placed between the vessel wall and the crushed stent to guide the manoeuvre. Discussion:Crushed stent is a rare complication, being caused by an incorrect passage of the guidewire between the stent's struts and the vessel wall in case of severe underexpansion. In this case, an IVUS-guided re-entry could be an option to gain the stent true lumen and avoid a second stent implantation.

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Retrograde-angioscopy guided wiring technique in chronic total occlusion lead to successful revascularization.

Project description:Endovascular therapy (EVT) was performed in two cases with chronic total occlusion (CTO) of superficial femoral artery. In these cases, angioscopy was deployed in the backyard of the CTO lesion from popliteal artery retrogradely, then the guidewire was advanced from antegrade. When the wire crossed the distal of the CTO lesion, the wire penetration was clearly visualized by the retrograde-angioscopy. Therefore, wire crossing of CTO into the distal true lumen was certainly confirmed, and EVT was successful. <Learning objective: Angioscopy-guided endovascular therapy for chronic total occlusion was useful not only to evaluate thrombus and plaque in situ visually, but also to successfully perform guidewire crossing.>.

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Through-and-through femorofemoral wire retrograde technique for the E-nside precannulated inner branch thoracoabdominal stent graft

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Looped wire advancement-not always safe! Fat-not so useless! a case series.

Project description:BackgroundCoronary artery perforation (CAP), although rare, can often be a life-threatening complication of percutaneous coronary intervention. Looped wire tip or buckling of wire is conventionally considered safer due to reduced risk of migration into smaller branches and false lumen. Occasionally, buckling can indicate the entry of tip into dissection plane, or the advancement of looped wire can cause small vessel injury leading to perforation. Distal coronary perforation can be life threatening and coil, foam, and thrombin injection are some of the material widely used for sealing it.Case summaryWe hereby report three different cases illustrating the vessel injury that the looped wire can cause in the distal vasculature related to various mechanisms like high elastic recoil tension, dissection by the non-leading wire tip, or hard wire lacerating the fragile small branches. All these mechanisms lead to distal coronary perforation leading to cardiac tamponade. Each case also illustrate the novel technique of autologous fat globule embolization for the management of distal CAP.DiscussionDistal coronary perforation is often due to guidewire-related vessel injury and is more common with hydrophilic wires. Looped wire tip can sometime indicate vessel injury and its advancement further down the coronary artery may result in serious vessel injury and perforation. Management of distal coronary perforation is challenging, and here we demonstrate the steps of using the readily available autologous fat globules by selectively injecting them into the small coronary artery to control the leak.

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