Hayakawa Naoki, Kodera Satoshi, Arakawa Masataka, Hirano Satoshi, Shakya Sandeep, Kanda Junji
Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.
CVIR Endovasc. 2021 Mar 4;4(1):27. doi: 10.1186/s42155-021-00217-7.
Surgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique "direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography" or "BAMBOO SPEAR."
This report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique "direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography" (BAMBOO SPEAR).
The BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.
股总动脉（CFA）疾病的外科动脉内膜切除术仍被视为治疗的金标准。各种技术和器械的发展改善了CFA血管内治疗（EVT）的临床效果。然而，仍存在严重情况，尤其是对于因钙化斑块导致的闭塞性病变。我们开发了一种有用的技术，即使用裸金属针直接穿透CFA的钙化斑块，然后通过球囊或对其进行扩张来通过病变。我们将此技术命名为“血管造影引导下股总动脉钙化斑块直接裸金属针穿刺及球囊血管成形术”或“竹矛术”。
本报告描述了我们使用针直接穿透CFA钙化斑块来通过病变的技术。我们报告了一例73岁接受血液透析的男性患者，其出现双下肢发绀和静息性缺血疼痛。对照血管造影显示左CFA完全闭塞并伴有钙化斑块。我们将一根略弯曲的21G金属针从远端CFA管腔所在处推进血管。在荧光透视引导下从多个方向观察时，将针推进钙化斑块中心。我们成功地将针推进到远端髂外动脉管腔。导丝穿过病变后，血管内超声（IVUS）显示导丝能够完全穿过钙化斑块中心。我们可以通过刻痕球囊和药物涂层球囊扩张病变。最终血管造影显示效果良好。我们将此技术命名为“血管造影引导下股总动脉钙化斑块直接裸金属针穿刺及球囊血管成形术”（竹矛术）。
对于伴有钙化斑块的闭塞性CFA的EVT，竹矛术可被视为一种有用的选择。
