高度石灰化PAD病変に対するPIERCE techniqueの有用性
市橋成夫
高度石灰化病変は下肢閉塞性動脈硬化症（PAD）の血管内治療において、最も難度の高いものである。例え病変のガイドワイヤー突破に成功しても、石灰化プラークがバルーンの通過や拡張を妨げる事がある。本稿では石灰化プラークを直接穿刺して石灰化に亀裂をいれるPIERCE techniqueを施行することで、バルーン通過や拡張に成功した症例を紹介する。
Heavy calcified arterial lesions are most challenging to endovascular procedures. Even after successful passage of a guidewire, a calcified plaque can hinder balloon passage or dilation of the lesions. Herein, we introduce a novel technique of percutaneous direct needle puncture of calcified plaque (PIERCE) to enable subsequent balloon passage and dilation of the lesion. PIERCE was performed in three patients with superficial femoral artery (SFA) lesions and one patient with a tibial artery lesion. In all four cases, balloon passage and lesion dilatation were achieved. Minor hemorrhage from the punctured tract occurred in two patients with SFA lesions, which resolved with stent placement and post dilation.
