Morph Catheter solves difficult left common iliac total occlusion after three failed attempts
Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP
Caritas St. Elizabeth’s Medical Center of Boston
Boston, MA
Background
A 70 year old male smoker presented with chronic total occlusion of the left common iliac artery, subtotal occlusion of the right common iliac artery, and patency of the external iliac arteries bilaterally.
Procedure
ACCESS
A 6 French x 23 cm Cordis Brite-tip sheath was placed retrograde in left common femoral artery (CFA). Unable to traverse the chronic total occlusion (CTO) despite using 4F x 65 cm support catheter and Cordis Frontrunner controlled blunt microdissection device. The Frontrunner kept taking a too medial subintimal orientation. A 6F Cordis renal internal mammary artery guide was then selected to try and stay centered without success. A looped Glidewire technique was tried, but was still unable to cross the CTO retrograde. Then the right CFA was accessed with a 7F x 23 cm Cordis Brite-tip sheath to advance a 6 French Morph deflectable guide catheter which can provide back up support over a 180 degree bend and we were able to cross the occlusion antegrade with the Boston Scientific Glidewire through the 6 French Morph catheter. This enabled crossing the CTO retrograde with another Glidewire and the 4F support catheter.
INTERVENTION
These Glidewires were exchanged out for two 300 cm .035 Wholey wires, and performed kissing PTA both iliacs, followed by kissing stents with two 8 x 59mm Cordis Genesis BE stents. A 10mm x 60mm Abbott Absolute SE stent was then placed from the distal CIA into the left external iliac. The BE Genesis stents were then post-dilated with two 9 x 40mm Cordis Opta Pro balloons, and the Absolute stent was post-dilated with an 8mm x 60 mm Cordis Opta Pro balloon and the overlap dilated with a 9mm x 40mm Cordis Opta Pro balloon. The sheaths were exchanged out for two 7F x 11cm Arrow sheaths, and hemostasis was achieved with two AccessClosure Mynx vascular closure devices.
Outcome
The Morph was used to allow crossing of CTO in an antegrade fashion when all retrograde attempts failed, despite using a controlled microdissection catheter. The case would have failed without the Morph because it provided a stable platform and allowed successful traversal of the left iliac CTO.
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