Introduction of novel intravascular ultrasound preceding with angled guiding catheter (I-PAD) technique to treat chronic total occlusions in peripheral artery disease

Mitsuo Sobajima; Teruhiko Imamura; Yohei Ueno; Hiroshi Onoda; Ryuichi Ushijima; Hiroshi Ueno; Koichiro Kinugawa

doi:10.1186/s42155-024-00469-z

Introduction of novel intravascular ultrasound preceding with angled guiding catheter (I-PAD) technique to treat chronic total occlusions in peripheral artery disease

CVIR Endovasc. 2024 Jul 11;7(1):54. doi: 10.1186/s42155-024-00469-z.

Authors

Mitsuo Sobajima¹, Teruhiko Imamura², Yohei Ueno², Hiroshi Onoda², Ryuichi Ushijima², Hiroshi Ueno², Koichiro Kinugawa²

Affiliations

¹ The Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama2630, Sugitani, Toyama, Japan. [email protected].
² The Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama2630, Sugitani, Toyama, Japan.

Abstract

Background: The optimal endovascular treatment (EVT) for chronic total occlusion (CTO) lesions in patients with peripheral artery disease (PAD) has remained unestablished. We encountered a patient with PAD in whom CTO was successfully treated using a novel technique that involved intravascular ultrasound (IVUS) and angled guiding catheter: IVUS Preceding with Angled guiDing catheter (I-PAD) technique.

Case presentation: A 74-year-old male presented with intermittent claudication attributed to CTO of the right external iliac artery. EVT was performed via the right common femoral artery. We retrogradely advanced the I-PAD system (i.e. partially extending the IVUS transducer portion from the tip of the angled guiding catheter) in the CTO lesion under the real-time guidance of IVUS imaging. We successfully traversed the CTO lesion without the use of a guidewire in approximately three minutes. The procedure concluded successfully without any procedure-related complications, following optimal stenting.

Conclusions: The I-PAD might be an effective technique to accurately, quickly, and safely pass through CTO lesions.

Keywords: Angled guiding catheter; Chronic total occlusion; Endovascular treatment; Intravascular ultrasound; Novel technique; Peripheral artery disease.