PMC8120600_01
Seventy-two-year-old male treated with bare-metal stent. (a) Right SFA occlusion before procedure. (b) After the conventional balloon angioplasty, major dissection was found. (c) Intravascular ultrasound showed dissection of 180 degrees. (d) The proximal lesion was treated with bailout stent and the distal lesion was treated with drug-coated balloon. (e) The procedure was completed after favorable blood flow. (f) Next day, a "low echoic area" around the stent that corresponded to the medial dissection. (g) There was no blood flow in the "low echoic area." (h) It was difficult to identify the presence of "low echoic area" at distal lesion treated with drug-coated balloon.
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The claudicant patient due to the right SFA occlusion was admitted to our hospital (Figure 3(a)). When conventional balloon angioplasty was performed after the guidewire passage, major dissection was found in the proximal SFA (Figure 3(b)). Intravascular ultrasound (IVUS) showed medial dissection of 180 degrees (Figure 3(c), arrow). Therefore, S.M.A.R.T. stent was implanted as the bailout stenting, and the distal lesion was treated with drug-coated balloon (DCB) (Figure 3(d)). The procedure was completed after favorable blood flow (Figure 3(e)). Next day, an LEA due to dissection was shown (Figure 3(f)). There was no blood flow in the LEA (Figure 3(g)). On the contrary, since the border of the lumen wall of distal unstented site was unclear, it was difficult to identify the presence of LEA in the DCB-treated lesion (Figure 3(h)).
PMC8120600_02
Seventy-one-year-old male treated with drug-coated stent: (a) Zilver PTX stent was implanted. (b) Next day, a "low echoic area" around stent was shown. (c) Six-month follow-up. (d) One-year follow-up. (e) 2.5-year follow-up.
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For claudicant patient due to the left SFA occlusion, Zilver PTX stent (Cook Medical, Bloomington, IN, USA) was implanted (Figure 4(a)). No complications were occurred after the procedure, but a surface echo on the following day showed an LEA around the stent implanted in the proximal SFA (Figure 4(b), arrow). No change and no symptom were observed during the follow-up period (Figure 4(c)-(e), arrow).