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Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach

Katsutoshi Takayama, MD, Ph.D

Department of Radiology and Interventional Neuroradiology

Ishinkai Yao General Hospital, Yao, Osaka, Japan

Disclosure

Speaker name:

Katsutoshi Takayama, M.D., ph. D

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

What is Wire rendezvous technique ?

・ Bidirectional approach using two guidewires and microcatheters to recanalize for long CTO.

What is Wire rendezvous technique ?

What is Wire rendezvous technique ?

・Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).

What is Wire rendezvous technique ?

・Advance antegrade guidewire into the retrograde microcatheter (Rendezvous).

What is Wire rendezvous technique ?

What is Wire rendezvous technique ?

What is Wire rendezvous technique ?

・Advance antegrade microcatheter

beyond CTO segment.

What is Wire rendezvous technique ?

・Advance antegrade microcatheter

beyond CTO segment.

What's the key benefits?

・Minimize subintimal tracking

・Less traumatic for recanalization

・Goose neck wire is not necessary

・Much higher recanalization rate of long

CTO

What is benefit of retrograde knuckle wire technique?

Journal of Clinical and Diagnostic Research. 2016 Sep, Vol-10(9):

What's the key benefits?

・Less bleeding due to vessel perforation

・Possibility of recanalization for CTO of no visible orifice of ATA , PTA , peroneal artery

What is benefit?

The loop could be advanced within the sub-intimal space without causing perforation.

Technical success rate 83.3%(55/66)

Vessel perforation 4.5 %(3/66)

Using 0.035 inch wire

J Endovasc Ther 2009;16:604–612.

Case 1

• Female / 80 year-old

• C/C : Ischemic rest pain

(Fontaine classification: III, Rutherford category 4)

• P/Hx : DM, HL – 7 years ago->Medication Tx

Percutaneous Coronary Intervention – 6 years ago

Laparoscopic cholecystectomy – 7 years ago

Stenting for bilateral SFA stenosis – 1 years ago

Stenting for bilateral CIA stenosis – 1 years ago

CTA

CTA

long CTO of left ATA and

peroneal artery 80F

long CTO of left ATA 80F

My strategy in this case

• Firstly I try to cross ATA occlusion using microcatheter

and 0.014 inch guidewire by antegrade approach.

• After recanalization I try to cross peroneal artery

occlusion using knuckle wire technique by retrograde

collateral approach.

• And finaly I planed to cross peroneal artery occlusion

using Rendezvous technique.

Recanalization of

left ATA occlusion

POBA for left ATA Rapid Cross 2.5/3mm x 21cm

(Medtronic Inc, Minneapolis, MN)

POBA for left ATA Rapid Cross 2.5/3mm x 21cm

POBA for left popliteal artery Rapid Cross 2.5/3mm x 21cm

Post POBA

Post POBA

Where is the orifice of PA ?

?

Collateral approach

Prominent Bta, GT 0.014 inch 45 angle

Collateral approach

Prominent Bta

GT 0.014 inch 45 angle

Rendezvous Technique

Retro : prominent Bta, GT 0.014 inch 45 angle

Ante : prominent NEO 135cm

Cross the lesion

POBA for peroneal artery

occlusion PTA balloon 3mm x 15cm

POBA for peroneal

artery occlusion PTA balloon 3mm x 15cm

Post Post PTA

Post

Post

ABI

Pre : 0.57

Post : 0.90

CASE 2

• Fale / 91 year-old

• C/C : Foot necrosis, Lt.3rd toe

(Fonatine classification: IV, Rutherford V)

• P/Hx : HT, HL – 10 years ago->Medication Tx

Cholecystitis – 4 years ago

Stenting for rt SFA occlusion, lt SFA stenosis, lt CIA

～EIA stenosis , PTA for rt BK lesion– 1 year ago

91 y.o. Female with foot necrosis

Lt.3rd toe

CTA

long CTO of left ATA 91 F

long CTO of left ATA 91 F

long CTO of left ATA 91 F

Retrograde approach

Prominent Bta 150cm

(Tokai Medical Products,

Aichi, JAPAN)

Regalia XS 1.0

(ASAHI INTECC,

Aichi, JAPAN)

GT wire 45 angle 180cm

(TERUMO CLINICAL

SUPPLY CO.,

Gifu, JAPAN)

Antegrade approach

Prominent NEO 135cm

(Tokai Medical Products,

Aichi, JAPAN)

Chevalier 14 floppy

(Johnson & Johnson K.K,

Paseo Padre Pkwy,

Fremont, CA USA)

Rendezvous Technique

Bellona 2.5mm x 12cm

(Medico's Hirata Inc.

3-4-3 Edobori, Nishi-ku, Osaka)

Bellona 2.5mm x 12cm

(Medico's Hirata Inc.

3-4-3 Edobori, Nishi-ku, Osaka)

SABER 3mm x 25cm

(Medtronic Inc, Minneapolis, MN)

SABER 3mm x 25cm

(Medtronic Inc, Minneapolis, MN)

Final angiography

Rendezvous point

Conclusion

Wire rendezvous and retrograde knuckle wire technique by collateral approach may be useful and safe for the long CTO of BTK lesion.

Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach

Katsutoshi Takayama, MD, Ph.D

Department of Radiology and Interventional Neuroradiology

Ishinkai Yao General Hospital, Yao, Osaka, Japan