[MO-51] Presentation Awards
A case of invaginated catheter tip during bidirectional approach for heavily calcified SFA occlusion.
【Case】 80 years old female.【Initial progress】She noticed intermittent claudication for 30m. CT shows severe calcification of her iliac and femoral arteries. Bil. SFA was totally occluded. EVT was planned for rt. femoral occlusion.【Procedure】The ipsilateral common femoral artery was punctured and a 6F sheath was inserted. The antegrade recanalization was failed and we switched to the retrograde approach. Distal SFA was punctured with a 21G needle and a 0.014 wire (Cruise) and a 0.014 microcatheter (Ichibanyari PAD2) were inserted retrogradely. Retrograde wire (Astato9-40) was successfully passed the CTO and pull through condition was established. The SFA was dilated by 2x40 balloon (JADE) and 5x180 balloon (JADE). Two 6x150 SMART stents were attempted to the entire CTO. The stent delivery system could not advance smoothly due to massive calcification. The retrograde microcatheter was advanced to the groin and delivery system was advanced by step by step manner. After stent delivery, a 6x120 balloon (SHIDEN HP) was inserted for high-pressure dilatation. But the balloon could not advance smoothly. After several minutes, we found that 2 markers existed at the tip of the balloon. And the tip maker of retrogradely inserted microcatheter was disappeared. We found an invaginated microcatheter tip in the balloon catheter lumen. 【Discussion】When doing the bidirectional approach, contact of the bidirectionally inserted catheter tips sometimes happen. In most of the case, we can feel some resistance and catheter movement is also observed. We can easily notice the contact. In this case, we can not feel so much resistance and invagination occurred. Dedicate microcatheter tip is so sharp that it can proceed into the lumen of the opposite catheter easily than before.【Conclusion】We experienced a very rare case of catheter invagination in bidirectional recanalization.