[MO-8] Presentation Awards
Successful IVUS guided Thrombectomy using Gastrointestinal Endoscopy Forceps
A case is 84-year-old male with intermittent claudication of the right lower limb. ABI showed 0.65. CTA and angiography revealed total occlusion from the right EIA to a part of CFA, and EIA was tortuous and large diameter with low CT value. There was no significant stenosis of the infrainguinal artery. EVT was performed via bifemoral approach. The systolic pressure gradient was 70mmHg. The retrograde guidewire crossing was easily successful with antegrade IVUS guidance. Thrombotic occlusion was suspected in these findings. After pulling the wire through the contralateral sheath, predilatation was performed with SHIDEN HP 4.0*100mm. Debris was not aspirated. Next, the EIA was fully covered with Absolute Pro 10.0*100mm and 10.0*60mm. The CFA lesion was treated with conventional balloon angioplasty because of non stenting zone. After dilatation with Senri 8.0*40mm, angiography showed the translucent image with mobility, suspected organized thrombus, at the CFA. Aspiration by the guiding catheter was not effective unfortunately, so thrombectomy using gastrointestinal endoscopy forceps, Radial Jaw, was tried. Our general technique for use of the forceps included the guidingsheath advancement to the target site, grasping the thrombus confirmed by contrast medium injection prior to extraction. In this case, IVUS guided thrombectomy using forceps was available because of bidirectional approach. It enabled to grasp the thrombus correctly in the real time. After thrombectomy, a large amount of organized thrombus was captured and it was successful to remove nearly without dissection and perforation. Final angiography showed good result and there was no pressure gradient. IVUS guided thrombectomy using gastrointestinal endoscopy forceps is a feasible technique.