Penetration of Calcified Lesions in Chronic Total Occlusion Using a Brockenbrough Needle

Endovascular treatment of calcified and occluded lesions remains a challenge. Dense calcifications in occlusive lesions hinder the advancement of guidewires, angioplasty balloon catheters, and stenting. We present a technique of piercing calcifications in a patient with chronic total occlusion (CTO)of the superficial femoral artery(SFA)using a Brockenbrough needle. The case was a 79-year-old man with resting pain in the left leg for a month. The ankle-brachial index in his left lower limb was 0.45. Duplex scanning and angiography revealed complete occlusion of the proximal left SFA. Endovascular treatment for the recanalization of the SFA-CTO was carried out using the bidirectional approach. Only the coronary CTO wire was able to cross the lesion, with the balloon catheters failing to cross. To widen the crossing site,a Brockenbrough needle was applied to penetrate the lesion. The needle successfully passed the lesion, and balloon passage was possible. Following predilatation, we deployed two Nitinol self-expandable stents. We confirmed the patency of this lesion with duplex sonography and angiogram 18 months later.Article信州医学雑誌 59(2): 97-102(2011)departmental bulletin pape