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The Go-BACK catheter is a novel device designed to be used for both intraluminal crossing or re-entry, into a vessel lumen from the subintimal space during subintimal angioplasty.
It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report our experience in recanalization of the chronic total occlusions of the common iliac artery (CIA) using the Go-BACK catheter, in cases where other techniques were unsuccessful.
One-third of the lesions in patients with peripheral artery obstructive disease (PAOD) affect the aortoiliac segment. Localized stenosis or occlusion of the infrarenal aorta occurs relatively infrequently and is generally associated with occlusive disease of the iliac arteries [
]. Although percutaneous intervention was born and developed as an alternative treatment to open surgical bypass, with the advent of angioplasty and stenting, this technique has evolved very quickly during the last decades [
]. A considerable impact of the procedural success rate was related to improved design and quality of the devices for these procedures, as well as the ease and accuracy of performing them, therefore leading to the preferential treatment of aortoiliac steno-obstructive disease by way of endovascular means with a high technical success rate and low morbidity [
]. In particular, the multifunctionality of the novel device GoBack™, helps to overcome difficult situations and avoids alternative approaches to the endovascular one. The GoBack™ Crossing Catheter (Upstream Peripheral Technologies, Caesaria - Israel) is a single-lumen crossing catheter which features a curved nitinol needle at the distal tip, with an adjustable protrusion length from a straight (3 mm) to a fully curved (11 mm) position, which allows it to be the only device that can be used either for intraluminal crossing and for subintimal reentry.
2. Case-presentation
A 75-year-old male was admitted for left sural claudication, AOCP II stage B (ILM 20 m) left lower limb from occlusion of the left common iliac artery. On the right, there was regular patency of the common iliac artery and common femoral artery. The patient underwent endovascular recanalization with access in both left and right common femoral artery under local anesthesia. The intervention was performed with systemic heparinization (5000 UI) and the support of 6 Fr introducer sheaths. Diagnostic angiography confirmed the occlusion of the left common iliac artery.
The 4 Fr GoBack™ Crossing Catheter (Upstream Peripheral Technologies, Caesaria - Israel) has been advanced in left iliac artery and using a 0.018'' guidewire Asahi Halberd, the recanalization was performed with re-entry into the abdominal aorta. The GoBack™ Crossing Catheter is a single lumen crossing catheter which features a curved nitinol needle that serves as an effective crossing tool. The device is available in 2.9 Fr (which allows to treat vessels with diameter up to 2 mm) and 4 Fr, with the compatibility respectively with 0.014″ and 0.018″ guidewires. The needle, protrudes from the catheter’s distal end and there are different options of needle protrusion, from a straight (3 mm) to a fully curved (11 mm) protrusion, that can be selected by the clinician using the device’s handle. A radio-opaque marker on the needle’s distal section provides guidance as to the needle tip axial and radial position and this facilitates easy steering of the instrument in the desired direction. The multifunctionality of this device allows to solve various situations, in which the classic endovascular techniques of recanalization are unsuccessful. The angiography through Pig-Tail catheter confirmed the presence of the guidewire in the true lumen of the Aorta.
Then the GoBack™ catheter was removed and a PTA was performed with a 6 × 200 mm low-profile Passeo-18 Biotronik balloon. Afterwards, on the left side, Viabahn covered stent ( Gore-USA)10 × 50 mm was placed imbricated with an Epic (Boston Scientific Corporation, Natick - USA)) bare-metal stent (10 × 60 mm), with distal landing in the external ipsilateral iliac artery.
Post-dilation was performed at 8 mm.
Final angiograms confirmed the patency of the aorto-iliac axis with excellent femoral pulsatility.
3. Conclusions
The GoBack™ Crossing Catheter is a single-lumen crossing catheter which features a nitinol needle that can be extended in a straight (2–3 mm) or fully curved (11–12 mm) configuration. The radio-opaque marker on the distal tip of the needle enables visualization of the axial and radial position of the tip, which facilitates instrument steering in the desired direction. The device is available in 2.9 F and 4 F, compatible with 0.014″ and 0.018″ guidewires, respectively. Above all, the multifunctionality of the device, as shown in the case reported, allows for its use both for re-entry from the subintimal space and for intraluminal crossing, which saves time and radiation exposure in complex recanalizations. The GoBack catheter enabled safe and effective crossing of an iliac occlusion. This crossing catheter may prove to be an useful tool in the interventional armamentarium, including for crossing and re-entry of iliac to tibial chronic total occlusions.Fig. 1, 2 and 3.
Fig. 1CT-scan and angiography image performed before the procedure.
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