Percutaneous bypass: subintimal recanalization of peripheral occlusive disease with IVUS guided luminal re-entry

Saketkhoo, Ramin R; Razavi, Mahmood K; Padidar, Arash; Kee, Stephen T; Sze, Daniel Y; Dake, Michael D

doi:10.1053/j.tvir.2004.01.006

« Previous Next »Techniques in Vascular & Interventional Radiology
Volume 7, Issue 1 , Pages 23-27, March 2004

Percutaneous bypass: subintimal recanalization of peripheral occlusive disease with IVUS guided luminal re-entry

Ramin R Saketkhoo, BA
- Department of Cardiovascular-Interventional Radiology, Stanford University, Stanford, CA, USA
Mahmood K Razavi, MD
- Department of Cardiovascular-Interventional Radiology, Stanford University, Stanford, CA, USA
- Address reprint requests to Mahmood K. Razavi, MD, Department of Cardiovascular-Interventional Radiology, Stanford University, 300 Pasteur Dr., Stanford, CA 94305 USA
Arash Padidar, MD
- Department of Cardiovascular-Interventional Radiology, Stanford University, Stanford, CA, USA
Stephen T Kee, MD
- Department of Cardiovascular-Interventional Radiology, Stanford University, Stanford, CA, USA
Daniel Y Sze, MD, PhD
- Department of Cardiovascular-Interventional Radiology, Stanford University, Stanford, CA, USA
Michael D Dake, MD
- Department of Cardiovascular-Interventional Radiology, Stanford University, Stanford, CA, USA

Abstract

Angioplasty of chronic total occlusions (CTOs) has lower technical success rates with longer procedure times and poorer outcomes. Subintimal recanalization remains limited by the lack of controlled re-entry into the true lumen of the target vessel. We report our experience using a commercially available catheter-based system equipped with an intravascular ultrasound scanner to achieve controlled true lumen re-entry in patients with peripheral CTOs. In a 4-month period, 6 patients with lower extremity (LE) ischemia from CTOs were treated. Occluded segments were crossed subintimally, and controlled re-entry was secured using the CrossPoint TransAccess catheter. This 6.2 F dual-lumen catheter contains an integrated 64-element phased array intravascular ultrasound scanner enabling targeting of structures. Intravascular ultrasound-guided luminal re-entry was achieved by advancing a 24-gauge needle to a desired length and delivering a 0.014” guide wire into the target lumen. The occluded segments were balloon dilated and stented using self-expanding nitinol stents. Effective luminal re-entry and re-establishment of antegrade flow occurred in all 6 patients. Time to recanalization ranged from 5 to 10 minutes. All patients were free of ischemic symptoms at 1 to 5 month follow-up. There were no procedure-related complications. Our preliminary results demonstrate the feasibility of using this catheter system for subintimal recanalization with controlled re-entry in CTOs. This approach can improve the technical success rate, reduce the time of the procedure, and minimize potential complications.