Retrograde salvage approach to treat tibial artery perforation during attempted revascularization of a chronically occluded artery

Arterial perforation is a well‐recognized complication of attempted percutaneous revascularization of a chronic totally occluded tibial artery and typically necessitates termination of the procedure. This report describes a step‐by‐step approach on how to perform a direct posterior tibial artery puncture and a sheathless wire introduction, to salvage a case of tibial artery perforation induced during attempted anterograde recanalization of an occluded tibial artery. After control of blood loss, retrograde wire passage and balloon inflation can facilitate relocation of the anterograde wire in the true lumen allowing uneventful completion of the procedure. © 2010 Wiley‐Liss, Inc.     

Treatment of a totally occluded superior mesenteric artery facilitated by retrograde crossing via collaterals from the celiac artery.

PURPOSE: To present a new approach route for recanalization of a chronically occluded superior mesenteric artery (SMA). TECHNIQUE: Percutaneous treatment of an SMA occlusion can be accomplished in some cases via retrograde crossing through collaterals from the celiac artery. From a right common femoral artery (CFA) approach, an 8-F RDC guide catheter is advanced to the origin of the celiac artery via. Using a 5-F angled Glidecath, a long 0.035-inch stiff Glidewire, and a Choice PT wire, the glide catheter is advanced via the celiac artery into the superior pancreaticoduodenal artery. Using the angled Glidewire and the Choice PT wire, the occluded SMA is cannulated in a retrograde fashion. Through an 8-F sheath in the left CFA, an 8-F RDC guide catheter is advanced into the abdominal aorta. A goose neck snare is used to capture the Choice wire, which is withdrawn through the left catheter and sheath. The SMA occlusion is dilated, and the RDC guide is advanced into the SMA origin over the balloon. Another Choice PT wire and a 0.035-inch Wholey High Torque wire are placed in an antegrade fashion through the now open SMA. Angioplasty and stenting are then completed in the SMA over the Wholey wire. CONCLUSION: Retrograde recanalization of the SMA via celiac collaterals offers a new endovascular approach to treating patients with chronic mesenteric ischemia and a chronically occluded SMA.     

Retrograde Recanalization of an occluded posterior tibial artery by using a posterior tibial cutdown: Two case reports

Recanalization of two occluded posterior tibial arteries was successfully achieved by utilizing a retrograde approach via a posterior tibial artery cutdown at the level of the ankle. Both cases were previously unsuccessfully attempted by using an antegrade approach. Thus, the choice of access vessel (arterial entry site) becomes a crucial determinant of angioplasty success.     

Angioplasty of a totally occluded right coronary artery

A new 6 French (F) guiding catheter with a large, teflon-coated internal lumen (4.2F) was developed, permitting use of the standard ultralow profile (< 3F) over-the-wire system. This small coronary angioplasty system (6F-PTCA) was evaluated in 48 lesions in 45 of 137 patients (33%) who underwent coronary angioplasty between September 1990 and January 1991. The mean age was 64 years (range 49 to 82); 37 (82%) were male. The procedure was via the brachial artery in 28 patients (62%). The overall primary success rate was 96%. It was 100% via the brachial artery and 90% via the femoral artery. There were no major complications. The puncture compression time with the 6F-PTCA via the brachial artery and via the femoral and with 8F-PTCA via the femoral was 3.8, 9.6, and 16.9 hr, respectively (P<0.001), although the procedure time of the 6F-PTCA via brachial and via femoral and of the 8F-PTCA was not significantly different. The mean hospital stay was 3.1, 4.5, and 5.5 days, respectively (P<0.01). A small hematoma occurred in 2 patients (4.4%) after the 6F-PTCA and in 3 (3.3%) after 8F-PTCA, and a large hematoma (>5 cm) was noted in 7 patients (7.6%) after 8F-PTCA. These results indicate that coronary angioplasty using the over-the-wire system through the new 6F guiding catheter is technically feasible. Moreover, this approach, especially when advanced via the brachial artery, could shorten the he-mostasis time and facilitate early ambulation. © 1992 Wiley-Liss, Inc.     

Angioplasty of a totally occluded right coronary artery.

We have presented a case of angioplasty of a chronically occluded right coronary artery. The occlusion had been present for 6 wks by clinical estimates. The length of the occluded segment (approximately 55 cm) did not preclude a successful outcome. Proper selection and manipulation of angioplasty equipment are, as in every case, critical for procedural success. Subintimal guidewire passage, though a frequent event, is occasionally associated with ischemic manifestations, and mandates detection and proper management. New approaches to PTCA of total coronary occlusions continue to be developed.     

Retrograde orbital atherectomy in an occluded superficial femoral artery

Superficial femoral artery (SFA) is commonly diseased in patients with symptomatic peripheral arterial disease. Endovascular treatments have been more effectively used for SFA occlusions with new techniques and devices. Retrograde popliteal access has been used as an alternative to increase the success rate of percutaneous transluminal angioplasty (PTA) of SFA after a failed antegrade attempt. Although orbital atherectomy (OA) has been used effectively to treat SFA occlusions, there are no reports of use of OA by retrograde popliteal approach.     

Coronary artery fistula related to dilatation of totally occluded vessel

Percutaneous transluminal coronary angioplasty (PTCA) is widely used to treat patients with coronary artery disease. Experience and improvement in catheters has led to its wider utilization. A case of coronary recanalization, complicated by coronary fistula created by an angioplasty guidewire, is reported.     

Intercoronary communication between left anterior descending artery and totally occluded right coronary artery

The author presents a patient with chronic total occlusion of the right coronary artery with a large lumen communication to the distal left anterior descending artery as a single conduit. The diameter of this connection was very large and equaled the distal left anterior descending artery diameter. The unusual finding of a large lumen connection between the left anterior descending artery and right coronary artery most likely represents a congenital coronary anomaly.     

A totally occluded right coronary artery presenting with a normal electrocardiogram

Total occlusion of the right coronary artery (RCA) typically manifests as ST-segment elevation in the inferior leads and sometimes the lateral precordial leads of the surface electrocardiogram (ECG). We report a case of a patient with a normal electrocardiogram on presentation who, on angiography, revealed a totally occluded proximal RCA. Emergency angioplasty and stenting was successfully able to recanalize the entire RCA and restore TIMI III flow. ECGs performed post-procedure showed minimal change. The existence of a subendocardial microvascular network may have allowed this patient to escape what typically would have been a large ST-elevation inferior myocardial infarction.     

Successful percutaneous revascularization of totally occluded left subclavian artery using orbital atherectomy

Subclavian artery steal (SAS) after coronary artery bypass graft (CABG) has been reported to be as high as 3.4%. These patients with patent left internal mammary artery (LIMA) anastomosis will also have coronary–subclavian steal syndrome (CSSS). Percutaneous intervention (PCI) by balloon angioplasty (BA) and stenting has been done successfully for subclavian artery (SA) stenosis. The visibility of the vertebral artery (VA) and LIMA during BA and stent positioning is extremely important. Debulking total occlusions by orbital atherectomy (OA) and avoiding unnecessary BA, stenting across side branches may decrease the chance of plaque shifting and subsequent loss of flow especially if they have ostial disease. Herein we report successful OA, BA and stenting of chronic total occlusion (CTO) of proximal left subclavian artery in a patient with coronary–subclavian steal syndrome with preservation of LIMA and diseased left vertebral artery (VA).     

Percutaneous coronary intervention in an anomalously arising totally occluded circumflex coronary artery

Congenital coronary anomalies are present in approximately 1% of the patients referred to cardiac catheterization. The present case describes a successful percutaneous coronary intervention in totally occluded left circumflex coronary artery (LCx) with an anomalous origin from right sinus of Valsalva. To the best of our knowledge this is the first case presented of successful recanalization of a chronic total occlusion in an anomalously arising LCx. The case highlights the feasibility of such a challenging procedure on the basis of the knowledge of coronary anatomy and the selection of appropriate guiding catheters and coronary wires.     

Emergency stenting of totally occluded left main coronary artery in acute myocardial infarction

We report a case of emergency stenting for acute occlusion of the left main coronary artery in the setting of acute myocardial infarction. Although stent implantation allowed prompt revascularization and successful immediate management of this life-threatening condition, subacute stent thrombosis occurred, requiring re-PTCA followed by surgical revascularization. This case suggests that stenting of an acutely occluded left main coronary artery may be a life-saving procedure but should only be used as a bridge to surgery rather than a definitive treatment modality.     

Retrograde recanalization of native coronary artery chronic occlusions via acutely occluded vein grafts

Treatment of acutely occluded saphenous vein grafts may be challenging due to large thrombus burden and diffuse disease. We report two cases of thrombotic saphenous vein graft occlusion, in which after percutaneous attempts to recanalize the saphenous vein graft failed, the target native coronary artery chronic total occlusions were successfully treated using a retrograde approach. © 2009 Wiley‐Liss, Inc.     

Laboratory markers at admission to predict the presence of totally occluded culprit artery in NSTEMI

A significant proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) have a totally occluded culprit artery (OCA). If these patients do not meet very high-risk criteria, they may be deprived of an immediate invasive strategy. Therefore, there is a need for markers that can predict OCA in patients with NSTEMI. A total of 357 consecutive patients with NSTEMI but without very high-risk criteria were included in this retrospective study. Two groups were formed: NSTEMI with OCA (n = 106) and NSTEMI with patent culprit artery (PCA) (n = 251). Complete blood count (CBC) and serum biochemical parameters obtained immediately at admission were compared between the groups. Receiver operating characteristic (ROC) analysis to predict the presence of OCA was performed for the parameters that were significantly different between the groups, and an area under the curve (AUC) > 0.7 was considered to suggest acceptable discrimination. Neutrophil count [8.13 (2.82‐27.88) × 10³/µL vs 5.59 (1.85‐19.71) × 10³/µL, P < .001] and aspartate aminotransferase (AST) level [45 (12‐405) U/L vs 25 (5‐143) U/L, P < .001] were significantly higher in patients with OCA. The AUC was 0.750 for neutrophil count and 0.731 for AST level. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of elevated neutrophil and/or AST levels for the presence of OCA were 77.4%, 70.1%, 52.2%, and 88.0%, respectively. More strikingly, the specificity was 95.2% in the presence of both neutrophil and AST elevation. Elevated neutrophil and/or AST levels at admission were strongly associated with the presence of OCA in patients with NSTEMI.     

Predictors for successful angioplasty of chronic totally occluded coronary arteries

AIMS: Reevaluation of clinical and angiographic predictors for percutaneous recanalization of coronary chronic total occlusion (CTO) using current techniques with conventional PTCA wires and balloons. METHODS AND RESULTS: We studied 253 consecutive patients with 283 lesions who underwent attempted PTCA of CTO (mean time since occlusion 33 months, range 3-150 month). Immediate procedural success rate was 84.8% (95% CI = 80.3%-88.6%). Multiple clinical and angiographic characteristics were evaluated as possible predictors of success/failure. Multiple logistic regression analysis revealed that a tapered morphology (P < 0.001, OR = 6.1; 95% CI = 2.1-18.2), 相似文献   

Stenting through a portacath for totally occluded superior vena cava in a case of non-Hodgkin s lymphoma

Superior vena cava (SVC) syndrome often presents with slowly progressive symptoms worsening over weeks or may cause abrupt symptoms and constitute a true medical emergency. Percutaneous intervention is the treatment of choice. We report a case of SVC stenting in a middle-aged woman with SVC obstruction secondary to portacath insertion for chemotherapy.