Retrograde Balloon-Assisted Approach to Prevent Distal Embolization During Complex Recanalization Procedures.

Autor:	Ysa A; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain., Lobato M; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain., Arroniz A; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain., Arruabarrena A; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain., Gómez R; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain., Quintana A; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain., Metcalfe M; Department of Vascular Surgery, Lister Hospital, Stevenage, UK., Fonseca JL; Department of Vascular Surgery, Hospital de Cruces, Barakaldo, Spain.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Aug; Vol. 31 (4), pp. 552-556. Date of Electronic Publication: 2022 Nov 22.
DOI:	10.1177/15266028221138024
Abstrakt:	Purpose: The purpose of the study is to describe a bailout technical strategy to prevent below-the-knee (BTK) distal embolization during procedures with increased inherent risk using universally-available "off-the-shelf" devices. Technique: A conventional retrograde access is obtained of the BTK target vessel where embolization protection is sought. Before starting any potential proximal maneuver with an associated significant risk of distal embolization (eg, atherectomy and mechanical thrombectomy), a low-profile balloon is inserted and inflated through the distal retrograde access, so that any debris resulting from the recanalization procedure is blocked by the stagnant column of blood generated by the inflated balloon. Once the revascularization procedure has been completed, a 4F curved catheter is antegradely advanced down to the distally-inflated balloon, and in case of distal embolization the debris is aspirated in a standard fashion way. Conclusion: A retrograde balloon-assisted "off-the-shelf" embolic protection approach may be considered for BTK revascularization procedures where there is an inherent increased risk of distal trash, especially in the presence of distal single-vessel runoff. Clinical Impact: Distal embolization following endovascular procedures can have devastating consequences and there is a general recommendation for selective use of EPDs in high-risk-scenarios. The increased cost and low availability of the current EPD devices for BTK/BTA arteries have prohibited their widespread use. The retrograde balloon-assisted "off-the-shelf" EPD prevents distal embolization during procedures with increased risk of distal trash using inexpensive, nonspecific equipment available in any basic endovascular suite. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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