2024 Volume 6 Issue 2 Pages 30-31
A 76-year-old male patient with peripheral artery disease (PAD) had received self-expandable stents (SMART 7.0×80 mm, 6.0×150 mm, and 6.0×150 mm) in the right superficial femoral artery (SFA) 6 years prior. Examinations revealed occluded stents (Figure A), and endovascular treatment of the lesion was planned. After crossing with a guidewire, the in-stent stenosis was dilated with a 6.0-mm plain balloon; blood flow after ballooning was normal (Figure B). However, the slow-flow phenomenon occurred after using high-dose drug-coated balloons (DCBs: Inpact 6.0×150 mm, 6.0×150 mm, and 6×60 mm; Figure C).
(A–C) Angiograms showing (A) stent occlusion in the right superficial femoral artery, (B) successful recanalization using conventional ballooning and (C) slow-flow phenomenon after using a drug-coated balloon. (D,E) Schematics of vasodilator injection using a dilated over-the-wire (OTW) balloon. (F) Final angiogram shows completely restored blood flow in the superficial femoral artery.
Based on established treatment protocols for slow-flow phenomenon in the coronary artery area, a dose of vasodilator, consisting of 40 mg papaverine and 2 mg nicorandil, was first injected via an inserted sheath; however, slow flow persisted due to leakage of the vasodilator into the SFA’s branch vessels. Subsequently, the same vasodilator was injected via a 0.035-inch over-the-wire (OTW) balloon inflated at the distal popliteal artery (Figure D,E). A crucial consideration during this intervention was the cautious injection of vasodilator, performed over ≥1 min, to avoid vessel injury and perforation. After this maneuver, the slow flow disappeared, and SFA flow was completely restored (Figure F).
We have presented a case involving a complication associated with the slow-flow phenomenon after DCB use, which was resolved by using a dilated OTW balloon for injection of vasodilator. If subsequent experiences validate its safety, this technique might be effective when use of DCB for prevention causes slow-flow phenomenon.
The authors declare that there are no conflicts of interest.
