Novel Intravascular Ultrasound-Guided Method to Create Transintimal Arterial Communications: Initial Experience in Peripheral Occlusive Disease and Aortic Dissection:

摘要: l Purpose: To report our experience using a commercially available catheter-based system equipped with an intravascular ultrasound (IVUS) transducer to achieve controlled true lumen re-entry in patients undergoing subintimal angioplasty for chronic total occlusions (CTO) or aortic dissections. Methods: During 8-month period, 10 (6 men; mean age 73.4 years) lower extremity (LE) ischemia from CTOs (n57) collapse dissections (n53) were treated. Subintimal access and of the performed 6.2-F dual-lumen catheter, which contained integrated 64-element phased-array IVUS deployable 24-G needle through guidewire was passed once target reached. The occluded segments balloon dilated; self-expanding nitinol stents deployed. In dissections, fen- estrations same device, unit acting as guide. fenestrations dilated stented support lumen. Results: Time effective ranged 6 minutes (mean 7) CTOs; antegrade flow restored all 7 CTOs, free ischemic symp- toms at up follow-up. dissection cases, equalized pressures between lumens into compromised vessels. There no complications related use this device any patients. Conclusions: Our preliminary results demonstrate feasibility catheter- based recanalization flap This approach can improve technical success rate, reduce time procedure, minimize potential complications. J Endovasc Ther 2004;11:274-280