It was reported that the balloon could not cross the lesion an the shaft broke.A 5x40mm sterling balloon and a 2.1 jetstream xc catheter were selected for use during a j-supreme ii study.The target lesion, located in the left distal superficial femoral artery (sfa) extending into the proximal popliteal artery, was 99% stenosed, had a reference vessel diameter of 6.0 mm, length of 130 mm and was classified as a tasc ii b lesion.The target lesion was treated with balloon angioplasty followed by debulking using the jetstream device, resulting in 50% residual stenosis.Post treatment, percutaneous transluminal balloon angioplasty (pta) was performed, with 25% final residual stenosis.During the procedure, ivus was passed through the middle of the popliteal artery, but a calcified nodule protruding into the intravascular lumen was observed.The sterling balloon could not pass through the lesion and the shaft broke making it unusable.The guidewire was changed to a thruway, and then atherectomy was performed a total of three times using the jetstream study device.Subsequent contrast images showed markedly slow flow and distal emboli of left anterior tibial artery, posterior tibial artery and peroneal artery of target limb was noted.Suction was first performed and the debris was successfully suctioned; flow improved.The original lesion was excavated using jetstream, and after pre-dilatation with a non-bsc balloon, drug application was performed using a non-bsc balloon.As it was concerned that the anterior tibial artery flow was poor in the final enhanced imaging, the wire cross was performed again to the anterior tibial artery.There was embolization of debris in the distal part of the anterior tibial artery, and suction catheter and non-bsc balloon could not pass through the same area.Since the non-bsc balloon could not pass through the lesion either, the back-up was enhanced using guidezilla, and then it was successfully passed.Dilatation was performed in the same area.With this dilatation, blood flow improved.The procedure was completed.The sheath was removed and hemostasis was performed using a non-bsc device.The event was considered recovered/resolved.The subject was discharged on aspirin and clopidogrel on (b)(6) 2019.
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