[MO-14] Successful bail-out procedure from implanted stent deformation induced by crossover advancement of the guiding sheath beyond the iliac bifurcation
A 71-year-old male who had a history of stent (Epic 10/60mm) implantation in his right common iliac artery (CIA), was admitted to our hospital for recurrence of claudication. Computed tomography angiography showed stenosis in the proximal right superficial femoral artery (SFA), and we performed endovascular treatment (EVT) via left common femoral artery (CFA). When advancing a 6Fr guiding sheath beyond the iliac bifurcation, tip of the guiding sheath collided with the proximal edge of the stent in the right CIA and caused stent deformation. To overcome this situation, we approached via the right CFA and tried to retrogradely advance a 0.014-inch floppy guidewire in the right course of the collapsed stent. However, it just resulted in passing through stent struts confirmed by intravascular ultrasound (IVUS). Then, we enhanced the maneuverability of antegrade 0.035-inch Radifocus guidewire by using a 4Fr Glidecath catheter, and successfully externalized the guidewire. After retrogradely changing the guidewire to a 0.014-inch one, we checked IVUS and confirmed the guidewire in the right course. Successively, we inflated a 6.0-mm balloon catheter at the collapsed lesion, and added a new self-expandable stent (Epic 10/40mm) proximally to the collapsed one. Finally, we achieved a favorable angiographical results. 3-month after this episode, we performed EVT for the initial targets in the right proximal SFA via left CFA similarly to the previous EVT. In this time, we safely used 0.018-inch inner system for crossover advancement of 6Fr guiding sheath.Iliac artery commonly has 4 curvatures.Because proximal CIA goes down to the back side, we have to pay attention when advancing a guiding sheath beyond the iliac bifurcation. We sometimes encounter this kind of complications in daily practice of EVT, so we report this instructive case with some considerations.