ENDOVASCULAR - Aorta Disease and Intervention
PTA of CTO of Subclavian Artery: Radial and Femoral Route
Max Super Speciality Hospital, India1,
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A 70-year-old male known case of diabetes, coronary artery disease, post PTCA to RCA and left main bifurcation presented with right upper limb claudication.On examination: Feeble RT radial puls, BP 146/84mmHg, Chest and CVS examination within normal limits
Relevant Test Results Prior to Catheterization
ECG: RBBB, sinus rhythm
Echo: RWMA in RCA territory, LVEF 50%
Relevant Catheterization Findings
CAG revealed patent left main and RCA stents and PAG revealed Rt subclavian artery 100% occluded.Plan: PTA/Stent to Rt subclavian artery from radial and femoral approach
Patient was taken for PTA to Right subclavian artery through dual route as the CTO was hilly type. Route: Right radial and Right femoral
Right JR guiding catheter taken from radial route and check shot taken,there was 100%occlusion of Right subclavian aretery. Gaia 2 guidewire crossed across the lesion with corsair support and balloon dilation done.
Now Terumo 0.35mm wire crossed across the lesion. Along 8F sheath put through right femoral route.Terumo wire snared into femoral sheath.
lesion dilated with 7x40mm balloon.XACT-8x60x40mm stent deployed Post dilation done with good end result
There are four types of Subclavian occlusion: Rat tail, peak, hilly and plain types
Rat tail and peak types are usually managed through transfemoral route.
Hilly (concave proximal cap) and plain types are usually crossed retrogradely approach from radial route as guide wire usually did not stabilise vial femoral route.The present case was of Hilly types done through dual route.As stent was of 8mm so it was deployed through femoral route.