Abstract No. 375 Nontraumatic intraluminal recanalization of difficult below-the-knee total occlusions using combination of laser ablation and wire back-end wire support in a crossing catheter

Abstract

To evaluate safety and effectiveness of an innovative technique of combining laser ablation and usage of wire-back-end support of a crossing catheter to treat below-the-knee total occlusion Twelve patients underwent conventional antegrade crossing techniques for below-the-knee tibial artery CTO using weighted tip wires and crossing catheters (Abbott). All had failed. The proximal calcium cap was ablated using laser atherectomy (Ra Medical Systems. An .014” crossing catheter was then placed against the CTO with the support of wire-back-end 1-mm inside and short of the crossing catheter tip. The catheter was pushed forward with firm pressure down to the ankle. Contrast was injected through the catheter to confirm intraluminal location. An .014” glide tip wire was used to complete the recanalization to the foot. This was followed by additional atherectomy and angioplasty. Twelve patients had average age of 69 (range, 62-89), 5 smokers, 5 with left leg lesions; 11 are diabetic. Each patient underwent conventional contralateral access antegrade crossing techniques using weighted tip wires (Abbott) and crossing catheters (Philips); and novel techniques using laser atherectomy (Ra Medical Systems) and wire back-end approach. 11 patients were technically successful with patent target tibial vessel at the end of the procedure. 8 patients had 6 months patency based on ultrasound, 4 had reocclusion. 3 patients had extravasation during the novel technique. 0 patients had postprocedural bleeding or hematoma in the calf. Combining laser ablation and wire back-end support in a crossing catheter is a safe and effective novel approach to recanalize difficult tibial CTO.