Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan.
Catheter Cardiovasc Interv. 2020 Nov;96(6):1317-1322. doi: 10.1002/ccd.29255. Epub 2020 Sep 15.
A severely calcified lesion is the most challenging entity in endovascular therapy (EVT) for below-the-knee (BTK) arteries. In this report, we introduce a challenging plaque modification technique known as the inner PIERCE technique. A 65-year-old man on hemodialysis with multiple toe ulcerations underwent an EVT for his BTK artery diseases. During EVT, the guidewire passed through the severely calcified posterior tibial and plantar arteries; however, the other devices could not pass through the lesion. Therefore, a novel inner PIERCE technique was performed. After guidewire externalization, an 18G 20 cm needle was advanced from the retrograde approach site, following the guidewire, for percutaneous transhepatic cholangiodrainage (PTCD). The PTCD needle was advanced into the severely calcified plaque using a rotational motion. Finally, the needle could pass through the lesion. After the inner PIERCE technique, an angioplasty was performed with a 2.5 mm balloon. The final angiography showed sufficient blood flow. After the EVT, complete wound healing was achieved in 4 months. This challenging technique may be an additional option for EVT to treat severely calcified BTK arteries.
严重钙化病变是膝下（BTK）动脉血管腔内治疗（EVT）最具挑战性的病变。在本报告中，我们介绍了一种名为 PIERCE 内技术的挑战性斑块修饰技术。一名 65 岁男性，因接受血液透析，出现多处脚趾溃疡，接受了 BTK 动脉疾病的 EVT。在 EVT 过程中，导丝穿过严重钙化的胫后和足底动脉；然而，其他器械无法通过病变部位。因此，采用了一种新的 PIERCE 内技术。导丝外置后，从逆行入路部位推进一根 18G 20cm 针，沿导丝进行经皮经肝胆管引流（PTCD）。PTCD 针采用旋转运动进入严重钙化斑块。最后，针可以通过病变部位。PIERCE 内技术后，使用 2.5mm 球囊进行血管成形术。最终的血管造影显示血流充足。EVT 后，4 个月后完全愈合。这种具有挑战性的技术可能是 EVT 治疗严重钙化 BTK 动脉的另一种选择。
