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. 2009:2009:687609.
doi: 10.4061/2009/687609. Epub 2009 Sep 1.

The results of a new distal protection method in intervention for chronic total occlusion of the superficial femoral artery

Tomoko Kobayashi  1 , Atsushi Funatsu, Emiko Ejima, Hiromi Muranishi, Makoto Utsunomiya, Kensaku Shibata, Masahiro Mizobuchi, Yoshihisa Enjoji, Shigeru Nakamura
Affiliations

The results of a new distal protection method in intervention for chronic total occlusion of the superficial femoral artery

Tomoko Kobayashi et al. Cardiol Res Pract. 2009.

Abstract

Aims. To determine the efficacy of a new distal protection method in SFA CTO interventions. Methods and Results. From June 2003 to February 2009, ninety-two consecutive, chronic total occlusions of superficial femoral arteries were treated with catheter-based intervention using a bidirectional approach. Nine of these cases were managed with our original, distal protection method, based on symptoms, angiographic images, wire resistance, and intravascular ultrasound images. The average age was 73 years; eight patients were male. The mean occlusion length was 17.1 cm. A distal protection balloon was inserted from the retrograde sheath in the popliteal artery and placed distal to the occluded lesion after successful wire crossing. Lesion dilatation with a balloon was performed antegradely and debris was removed by 6Fr. guiding catheter. Debris was retrieved from all lesions, consisting mainly of thrombus. Where we decided not to use the distal protection method, there was no distal thromboembolism. Conclusion. In SFA-CTO intervention, the risk of distal embolization is 10%, which can be anticipated and eliminated by the distal protection method.

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Figures

Figure 1
Figure 1
Preprocedural angiogram showed occlusion of the superficial femoral artery. The contrast agent was hazy at the distal end.
Figure 2
Figure 2
An IVUS image showed that the lesion was occupied with mixed plaque.
Figure 3
Figure 3
On IVUS the plaque consisted of two layers. The center of the plaque, a layer of low echogenicity, was mobile.
Figure 4
Figure 4
The distal PTA balloon was inserted using a retrograde approach and inflated to protect against thromboemboli. The proximal PTA balloon was inserted antegrade and used to dilate the occlusion site.
Figure 5
Figure 5
The catheter was inserted and used to suck up debris.
Figure 6
Figure 6
The self-expanding stents were implanted.
Figure 7
Figure 7
After postdilation, debris was sucked out again.
Figure 8
Figure 8
We checked for the absence of debris at the distal end of the CTO lesion by injecting dye through the tip of the lumen of the occlusion.
Figure 9
Figure 9
The final angiogram showed good runoff and no distal embolism.
Figure 10
Figure 10
Specimen retrieved from the catheter.
Figure 11
Figure 11
Hematoxylin and eosin stain of debris showed fibrin thrombus with inflammatory cells and immature endothelial cells.
See this image and copyright information in PMC

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