Case

Total Occluded Left Subclavian Artery Lesion Treated by Stent Implantation

- Operator : Kazushi Urasawa

Total Occluded Left Subclavian Artery Lesion Treated by Stent Implantation
- Operator: Kazushi Urasawa, MD
Case Presentation
A 66 year-old gentleman was admitted for dizziness and presyncope. His MRA showed totally occluded left subclavian artery (SCA) and he was diagnosed as subclavian steal syndrome. Three years ago, he underwent PCI at RCA with three Endeavor Resolute stents. He also has a past medical history of left lower peripheral angioplasty one month ago. His cardiovascular risk factors were diabetes, hyperlipidemia, hypertension, and ex-smoking.
Baseline Angiography
The peripheral angiogram showed total occlusion of left subclavian artery ( Movie 1).
Procedural Step
An 8 Fr sized sheath was inserted into the right femoral artery and a 6 Fr sized sheath was also inserted into the left brachial artery for bidirectional approach. Initially, by using the Finecross microcatheter, antegrade approach with Miracle 6 wire was tried into Lt. SCA (Figure 1). However, we failed. And then, antegrade approach with another Conquest pro 12 wire was also failed. Retrograde approach with Conquest pro 12 wire was tried to pass the Lt. SCA lesion (Figure 2), but failed again. After that, antegrade approach with a 0.014 inch Peri 30G wire was tried into Lt. SCA. However, we failed again. Finally, a 0.014 inch Astato XS 9-12 wire could cross Lt. SCA ( Movie 2). And then, we checked wire position using VU IVUS. After IVUS check-up, we performed several small predilatations with an Amadeus 2.0x20mm balloon at Lt.SCA. After exchanging Astato XS 9-12 wire into a 0.014 inch Flexi-cut wire (Figure 3), several small predilatations with an Amadeus 2.0x20mm balloon at Lt. SCA were done ( Movie 3). And then, two guiding catheters (8 Fr and 6 Fr) were overlapped and we aspirated debris to avoid distal embolizations ( Movie 4). After aspiration, a 7.0x39 mm sized Palmaz Cornithian stent was deployed (Figure 4). Final angiogram showed good result ( Movie 5).

Comments

  • Bing Liu 2012-06-04 Facilities were more essential than strategies
  • Sunarya Soerianata 2012-07-10 what guiding catheters were used?

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