title: New endovascular technique for thrombus in the non-stenting zone-the Grab a Clot and Hold ON "(GACHON) technique": Case report.
abstract: It is difficult to treat a thrombotic embolism in the common femoral artery or popliteal artery (POP A), i.e., the non-stenting zone. We report a new technique for the treatment of thrombotic embolism in the non-stenting zone using a self-expandable nitinol stent. Case 1 had an external iliac artery (EIA) occlusion that occurred over several months. A self-expandable nitinol stent was placed in the right EIA lesion via a retrograde approach using a distal 9-Fr balloon protection guide catheter in the right femoral artery. A thrombotic embolism occurred at the balloon protection site. It was too big to be removed using an aspiration catheter; therefore, we attempted removal with a self-expandable stent. Using a crossover approach, we delivered a nitinol self-expandable stent to the distal site of the thrombus, opened the tip of the stent, and pulled it up to the proximal site. Finally, we "grabbed a clot," moved it to the stenting zone, and "held on" the vessel wall without occurrence of a distal embolism. We named this the "GACHON technique." Case 2 underwent endovascular therapy for an acute thrombotic embolism in POP A after thoracic endovascular aortic repair for dissection. This thrombus was too big to aspirate, and we successfully treated it using the "GACHON technique." The "GACHON technique" may be considered as a choice of treatment for a thrombotic embolism in the non-stenting zone. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000792:Angiography; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D000069322:Self Expandable Metallic Stents; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000497:Alloys; C013616:nitinol
keywords: endovascular intervention; peripheral angiography; peripheral arterial disease; peripheral intervention; stenting technique