[MO-12] Presentation Awards
Successful guidewire externalization by trapping the retrograde guidewire inside the antegrade guiding catheter-extension device in endovascular treatment for severely calcified infra-popliteal lesion
A 74-year-old female had a cellulitis and refractory ulcer formation in her left leg. Computed tomography angiography showed occlusion below the popliteal artery accompanied with severely calcified plaque. We suspected ischemic etiology of the refractory ulceration, and we tried to perform endovascular treatment (EVT) for the below-the-knee (BK) lesions. From the beginning, we established a bidirectional approach from both common femoral artery and dorsal artery. Retrograde guidewire was advanced to the proximal position relatively with ease, but microcatheter could not be advanced over the retrograde guidewire due to severe calcification. Therefore, we managed to advance a guidewire alone and successfully introduced it inside the guiding sheath at the popliteal artery. Next, we tried to retrogradely advance microcatheter by trapping the retrograde guidewire with a balloon inflation inside the guiding sheath. However, we could not do that even under this situation.Therefore, we antegradely introduced a guiding catheter-extension device, and trapped the retrograde guidewire with a balloon inflation inside the guiding catheter-extension device. Then, we pulled the guiding catheter-extension device back outside the guiding sheath, and finally succeeded in “pull-through” of the retrograde guidewire. We expanded the anterior tibial artery with a balloon catheter and achieved a favorable one straight line.In EVT for BK lesions with severe calcification, we encounter some cases such that no device can pass even though guidewire has passed. In this situation, if guidewire externalization is completed, we can use BAD FORM technique for the purpose of device delivery. However, guidewire externalization itself was difficult to be performed in our case. Although we usually use a snare catheter in this situation,we economically achieved successful EVT by devising our procedures.