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CASE20191115_035
| ENDOVASCULAR - Peripheral Vascular Disease and Intervention | |
| Efficacy of the CROSSER System for Multiple Lesion Flossing with Subsequent Angioplasty to Modify Heavily Calcified Lesions in Common Femoral Artery (CRASH) | |
| Nagatomi Satoru1, Ichihashi Shigeo1, Masahiro Inagaki1, Kichikawa Kimihiko1 | |
| Nara Medical University, Japan1, | |
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[Clinical Information]
- Patient initials or identifier number:
S.F
-Relevant clinical history and physical exam:
Severely calcified lesion is one of the most challenging cases in endovascular treatment. The calcified plaque can inhibit the sufficient expansion of the lesions. We developed a novel CRASH technique useful for lesion modifications and following lesion expansion. From September 2016 to August 2019, the CRASH technique was indicated for four patients suffering from intermittent claudication or critical limb ischemia due to severely calcified CFA stenosis.
-Relevant test results prior to catheterization:
Contrast enhanced CT shows severe calcified stenosis in common femoral artery in all of 4 cases.
- Relevant catheterization findings:
Initial angiogram revealed severe calcified stenosis in common femoral artery as with the findings of contrast enhanced CT in all of 4 cases. |
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[Interventional Management]
- Procedural step:
After successful guidewire passage, flossing the lesions by CROSSER system was conducted, followed by balloon angioplasty using non-compliant balloons or scoring balloons. Then another guidewire was attempted to penetrate through a different part of the calcified plaques, followed by CROSSER flossing and balloon angioplasty. The procedure was repeated via 4 routes in three cases and 2 routes in the other case. Technical and clinical successes were achieved in all cases. The angiogram followed by CRASH revealed favorable antegrade flow and sufficiently dilated lesion without the need for stent implantation. Immediately after the procedure, ankle brachial index values increased and symptoms of the patients improved.
- Case Summary:
The CRASH technique facilitated the sufficient expansion of the CFA lesions in our cases and reveal the favorable short-term outcomes. Further study is needed to reveal its feasibility and long term efficacy.
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