Percuataneous Recanalization of CTO of Right Common Iliac Artery using Conventional Coronary Angioplasty Guidewire

- Operator : Seong-Wook Park

Percuataneous Recanalization of CTO of Right Common Iliac Artery using Conventional Coronary Angioplasty Guidewire

- Operator : Seong-Wook Park, MD

Case presentation
The patient was 55 years old male and he had intermitted claudication from March.2002.
He had 30 pack-year of smoking as a coronary risk factor. His base line ECG showed normal. Vascular lab studies demonstrated an ABI (ankle-brachial index) of 0.52 in the right leg with pressure drop off at the thigh.
Baseline angiogram

1. Baseline angiogram showed that chronic total occlusion (CTO) at right common iliac artery (Figure 1).

2. Coronary angiogram was normal.

Procedure
A 8F sheath was inserted through right common femoral artery. We couldnot cross the CTO of right common iliac artery by 0.035-inch hydrophilic guidewire. We exchanged the guidewire to conventional coronary angioplasty guidewire. Then we could cross the CTO lesion with alternative use of 0.014-inch Shinobi and Floppy coronary angioplasty guidewire. After which, however, the peripheral balloon (Ultrathin) could not be advanced into lesion. Then percutaneous transluminl angioplasty (PTA) was performed by using 3.0 x 20 mm lower profile balloon developed for coronary angioplasty (Figure 2), and additional PTA with 7.0 x 20 mm balloon was done at 14atm (Figure 3). After PTA, We found dissection and remained narrowings of the lesion (Figure 4). Next Symphony stent (8.0 x 23 mm) were successfully deployed at the lesion site (Figure 5). The stent was then post-dilated with 7.0 x 20 mm balloon at 14 atm for angiographic optimization (Figure 6). The completion angiogram (Figure 7) demonstrates repair of the dissection and good patency and the patient was almost completely free from symptoms.

Leave a comment

Sign in to leave a comment.