Hayakawa Naoki, Kodera Satoshi, Hirano Satoshi, Arakawa Masataka, Inoguchi Yasunori, Kanda Junji
Department of Cardiovascular Medicine, Asahi General Hospital, I-1326, Chiba, 289-2511, Asahi, Japan.
Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan.
CVIR Endovasc. 2022 Mar 26;5(1):18. doi: 10.1186/s42155-022-00294-2.
Although endovascular therapy is used to treat chronic limb-threatening ischemia, long chronic total occlusion (CTO) is still challenging to treat. Especially in patients with poor run-off below-the-knee (BTK) arteries, it is difficult to perform a retrograde approach, and even guidewire passage may be difficult.
We treated two cases of chronic limb-threatening ischemia using our novel extreme antegrade guidewire crossing technique by AnteOwl WR intravascular ultrasound (IVUS)-guided parallel wiring to a BTK artery (EXCAVATOR technique). Case 1 was a 70-year-old man with ulceration of the right toe. The AnteOwl WR IVUS was intentionally advanced into the subintimal space of the posterior tibial artery, and the totally intraplaque route was advanced by IVUS-guided parallel wiring that was successfully passed from the lateral plantar aspect to the true lumen of the digital artery. Case 2 was a 76-year-old woman with rest pain and cyanosis of the right lower limb. Angiography showed total occlusion from the superficial femoral artery to BTK arteries. AnteOwl WR IVUS-guided parallel wiring was repeatedly performed until the distal true lumen of the peroneal artery was reached, and revascularization was successfully achieved via the antegrade approach alone.
With its excellent crossable performance, good image quality, and high navigational ability within the CTO, the AnteOwl WR can be used to pass parallel wiring into the distal true lumen for BTK CTO.
尽管血管内治疗用于治疗慢性肢体威胁性缺血，但长段慢性完全闭塞（CTO）的治疗仍然具有挑战性。特别是在膝下（BTK）动脉流出道不佳的患者中，逆行入路难以实施，甚至导丝通过也可能困难。
我们使用我们新颖的极正向导丝穿过技术，即通过AnteOwl WR血管内超声（IVUS）引导的平行布线至BTK动脉（EXCAVATOR技术），治疗了2例慢性肢体威胁性缺血患者。病例1是一名70岁男性，右脚趾溃疡。将AnteOwl WR IVUS有意推进至胫后动脉的内膜下间隙，并通过IVUS引导的平行布线推进完全位于斑块内的路径，该路径成功地从足底外侧进入趾动脉的真腔。病例2是一名76岁女性，右下肢静息痛和发绀。血管造影显示从股浅动脉到BTK动脉完全闭塞。反复进行AnteOwl WR IVUS引导的平行布线，直到到达腓动脉的远端真腔，仅通过正向入路就成功实现了血运重建。
凭借其出色的可穿越性能、良好的图像质量以及在CTO内的高导航能力，AnteOwl WR可用于将平行布线穿过至BTK CTO的远端真腔。
