CTO PCI Techniques May Be Transferrable to Peripheral Vascular System

Techniques used in chronic total occlusion (CTO) PCI may be transferrable to the peripheral vascular system, according to a case published Dec. 16 in JACC: Case Reports.

Conor McQuillan, MBBCh, et al., describe a case of recanalization of an occluded radial artery that was dissected and reentered using CTO techniques before revascularization. The patient was a 71-year-old female referred for coronary angiography for angina. The patient had history of ischemic heart disease, diabetes and hypertension and was overweight. She previously had PCI via radial and femoral access and experienced femoral vascular complications.

Coronary angiography was performed via radial access. After accessing the radial artery, the authors noted an occlusion and possible dissection with clear delineation of a dual-lumen system and bridging collateral vessels. They used a hydrophilic coronary guidewire to negotiate the small lumen and facilitate reentry into the true lumen of the radial artery. Balloon dilation and balloon-assisted tracking were then used to guide the catheters to the aorta and complete the case.

According to the authors, the case demonstrates that CTO PCI techniques can be transferred to the peripheral vascular system. "Greater collaboration and joint education events between coronary and peripheral operators are required to obtain the best clinical outcomes for patients," they conclude.

There are "specific challenges" with radial access, including radial artery occlusion, Bartosz Hudzik, MD, PhD, FACC, and Mladen I. Vidovich, MD, FACC, write in an accompanying editorial comment. The case "demonstrates that coronary techniques can be safely and successfully adopted in the treatment of radial access complications" and "highlights that synergies between coronary and peripheral intervention programs can increase clinicians' expertise to further improve outcomes and manage complications," they write.

Check out the full December issue of JACC: Case Reports here.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Interventions and Imaging, Angiography, Nuclear Imaging, Hypertension

Keywords: Radial Artery, Coronary Angiography, Percutaneous Coronary Intervention, Dilatation, Coronary Vessels, Angina Pectoris, Myocardial Ischemia, Heart, Hypertension, Aorta, Diabetes Mellitus, Overweight

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