- Procedural step: Firstly, we tried antegrade intervention with Rt.femoral route. A 7 Fr sized femoral sheaths was inserted into the right femoral artery. Using 5 Fr head-hunter catheter, and JR4 7 Fr guiding catheter was tried to engage into subclavian artery ostium. But 0.014 inch guidewire (Fielder FC and Choice-PT) could not be advanced due to weak weak guiding back-up support.(Figure 4) Some trial with balloon support wiring made a small antegrade flow. So, we changed strategy into retrograde approach. We punctured weakly palpable radial artery with 7Fr sheath. After advance to lesion with 5 Fr head-hunter catheter, 0.014 inch Choice-PT wire with 6 Fr Export aspiration catheter was passed the lesion successfully. We changed guidewire into 0.014 inch 300cm Flexicut-wire. Prediation with RIDER 4.0 * 40mm balloon was performed. (Figure 5, Figure 6, Figure 7) Sequentially, balloon expandable Express 7.0 * 37 mm stent was deployed.(Figure 8) Post-stent balloon dilation with stent balloon upto 7.0 (6 atm) was performed.(Figure 9) Final angiogram showed well-positioned stent in both CIAs.(Figure 10) |
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