Crush Stent Technique: A New Approach for Occluded Iliac Stent

Background: Iliac stent thrombosis is problematic. Surgery is often indicated because endovascular recanalization of the occluded stent is difficult. Some interventional cardiologists described a new technique to manage occlusion of coronary stent, the “Crush stent technique” consist on subintimal recanalization and swatting of the “old stent”. The aim of this report was to demonstrate the feasibility and safety of this technique also for iliac artery. Method(s): A 55 years old woman was admitted in our department for a critical lower limb ischemia due to thrombosis of left common iliac stent implanted 2 years earlier for claudication. The ankle-brachial index was 0.5. Our initial strategy was to cross intraluminally the occlusion and to use a drug-eluting balloon. However, we failed to achieve an intraluminally stent recanalization, so we performed a subintimal recanalization of the occluded stent. The wire crossed the occlusion completely outside stent through the subintimal space. Firstly, we performed a balloon angioplasty, a 7 mm balloon was inflated at eight ATM pressure and contributed in crushing of the thrombosed stent. Therefore, we deployed an 8 x 80 mm Wall-Stent (Boston Scientific), covering all the common and external iliac artery. Result(s): Final angiography was satisfactory showing a patent iliac conduit with a total flattering of the old stent. Post operative course was favorable with symptomatic relieve, the left ankle-brachial index was improved to 0.85 and duplex ultrasound showed patency of the wall stent at 1 and 6 months. There was no hemodynamic disturbance particularly at the site of the subintimal crush. Conclusion(s): Crush stent technique is not only feasible for coronary stent thrombosis but can also be performed for peripheral arterial stent thrombosis especially when intraluminally stent recanalization cannot be achieved. In our knowledge, it is the first report in the literature of a “crushed stent” technique for a thrombosed iliac stent.

 

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Artikel online veröffentlicht:
11. Mai 2021