JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO.

16, SUPPL S, 2016 S343

severe residual stenosis was observed. On IVUS performed at this

time point, the stent was observed to be partially collapsed. With no
other measures that could be taken, we decided to finish the proce-
dure and wait for expansion of the stent with its function of self-
expanding.
After this EVT procedure, anticoagulant therapy was resumed at a
higher dose. One and half months after surgery, spontaneous stent
expansion and subsequent reperfusion were achieved.

Case Summary. Re-occluded SFA contains a large amount of throm-

busafter long stenting, and is refractory to treatment or may cause
furtherimpairment of blood flow. It is also difficult to advance a wire
through suchocclusive lesions. Medical interventionalists are well
trained in treating occlusivelesions, but not capable of getting a
massive thrombus out of the body, whilevascular surgeons are
capable of removing massive thrombus, but not experiencedin EVT
for treatment of occlusive lesions.
Hybrid EVT, a collaborative approach by medical interventionalists
and vascularsurgeons, progresses a very safe and reliable approach for
revascularization.

TCTAP C-202
Hybrid Endovascular Therapy Combined with Fogarty Thrombectomy in a
Patient with Thromboembolic Lesion in Iliac Artery Region Secondary to
Atrial Fibrillation
Akimitsu Tanaka,1 Masayuki Nakamura1
1
Nagoya Tokushukai General Hospital, Japan

[CLINICAL INFORMATION]
Patient initials or identifier number. T.I
Relevant clinical history and physical exam. A 77-year-old man with AF
was admitted to the urology department of our hospital for treatment
of prostatic cancer.
Anticoagulant administration was temporarily discontinued in
preparation of surgery. Obe week after discontinuation of anticoagu-
lant, he experienced sudden onset of leg pain, and became unable to
walk even for a while. Because of persistent pain at rest, he was
referred to our department.
Relevant test results prior to catheterization. CT revealed an obstructing
lesion extending from the distal aorta to the proximal portions of the
bilateral common iliac arteries. Hence, emergency surgery with
Fogarty thrombectomy was performed.
Relevant catheterization findings. Aortogram with pigtail catheter
revealed a translucent area extending from the distal aorta to the
bifurcation of the CIA, consistent with the CT findings, indicating
reduced blood flow.
[INTERVENTIONAL MANAGEMENT]
Procedural step. We did thrombectomy with Fogarty, while we pro-
tected bi-IIA with Filtrap. But only a small amount of thrombus was
removed, with failure to restore the impaired blood flow. The situa-
tion was not improved even with additional balloon dilatation at the
same site.
Severe stenosis still remained on angiography and IVUS.
The same procedures were repeated, with better results. Conse-
quently, stent deployment was performed on the left side, where

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Case Summary. Thromboembolic lesions secondary to atrial fibrillation

should be treated by distinct EVT strategies from those used for
arteriosclerotic lesions. However, it is sometimes hard to distinguish
thrombotic lesions from arteriosclerotic lesions, and these lesions
often coexist. Since there have been only a limited number of reports
on EVT for highly organized thromboembolic lesions as reported here,
it is meaningful for interventionalists to understand the behavior and
response to treatment of such lesions.

TCTAP C-203
Successful Percutaneous Renal Artery Angioplasty of Branch Occlusion
Caused by Spontaneous Renal Artery Dissection
Minato Hayashi,1 Hiroaki Yamamoto,1 Hideo Miura,1 Chieko Itamoto,1
Tsunesuke Kohno1
1
Nagano Chuo Hospital, Japan

[CLINICAL INFORMATION]
Patient initials or identifier number. 00002721
Relevant clinical history and physical exam. Patient is 50 year-old man
with no past medical history. He smoked 15cigarettes a day. He was
awoken up by left flank pain. The pain lasted for 2days before inter-
vention. His blood pressure is 137/96 mmHg, slightly higher indiastole
phase. Other vital signs are within normal limits. He had tendernessat
left costovertebral angle. Contrast enhanced CT showed poorly con-
trastedleft kidney at upper pole. CT angiography showed intimal flap
in main branch ofrenal artery.
Relevant test results prior to catheterization. Laboratory evaluation
revealed a lactate dehydrogenase level of 600 IU/l,a serum creatinine
level of 0.99 mg/dl, a renin activity level of 3 g/ml/h,aC-reactive
protein level of 16.54 mg/dl, fibrin degradation products levelof5.4 mg/
mland a white blood cell count of 18360 cells/mm3 with 83.4 % neu-
trophils.Urinalysis was slightly positive.
[INTERVENTIONAL MANAGEMENT]
Procedural step. We decided to do renal artery angioplasty because
thepain was on going.
We choose JL 3.5 mm for the guide catheter. Renal artery angiog-
raphy revealed anintimal flap at occluded branch. We chose cruise
for guide wire. One cruise wasinserted up to patant branch and other
cruise was inserted up to occludedbranch. We observed the renal
artery with intravascular ultrasound. Thediameter of the vessel was
7mm. We use balloon2.0 mm in diameter and 20 mm longand Case Summary. We report a case of endovascular therapywith POBA.
balloon 3.0 mm in diameter and 20mm long to expand the occluded After the intervention, the pain was lost and not recurred. Thelevel of
branch. Wedidn’t place stent because of too large diameter of the LDH, which reflects the severity of renal infarction was reduced
occluded branchand the affair of occlusion of the patant branch by afterintervention. Contrast enhanced CT 1 month after the interven-
stenting. tion revealed thereduced volume of uncontrasted area of kidney. His
renal function was not getworse after 6 month follow up. This case
suggests the usefulness of renal interventionespecially in case which
has great difficulties to place the stent.

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