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Efficacy of the novel inner PIERCE technique for severely calcified below‐the‐knee occlusions in a patient with chronic limb‐threatening ischemia
Author(s) -
Nakama Tatsuya,
Muraishi Makio,
Obunai Kotaro,
Watanabe Hiroyuki
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29255
Subject(s) - medicine , lesion , angioplasty , radiology , bruton's tyrosine kinase , critical limb ischemia , percutaneous , posterior tibial artery , balloon , artery , surgery , vascular disease , arterial disease , receptor , tyrosine kinase
A severely calcified lesion is the most challenging entity in endovascular therapy (EVT) for below‐the‐knee (BTK) arteries. In this report, we introduce a challenging plaque modification technique known as the inner PIERCE technique. A 65‐year‐old man on hemodialysis with multiple toe ulcerations underwent an EVT for his BTK artery diseases. During EVT, the guidewire passed through the severely calcified posterior tibial and plantar arteries; however, the other devices could not pass through the lesion. Therefore, a novel inner PIERCE technique was performed. After guidewire externalization, an 18G 20 cm needle was advanced from the retrograde approach site, following the guidewire, for percutaneous transhepatic cholangiodrainage (PTCD). The PTCD needle was advanced into the severely calcified plaque using a rotational motion. Finally, the needle could pass through the lesion. After the inner PIERCE technique, an angioplasty was performed with a 2.5 mm balloon. The final angiography showed sufficient blood flow. After the EVT, complete wound healing was achieved in 4 months. This challenging technique may be an additional option for EVT to treat severely calcified BTK arteries.