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.
