The extravascular plaque modulation technique: A novel strategy to facilitate guidewire crossing in noncrossable calcified tibial chronic total occlusions
Karthigesu Aimanan, Michael Arvind, Putera Mas Pian, Hanif Hussein · 2026
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Description
Karthigesu Aimanan and colleagues describe squeezing a blocked, calcified shin artery from outside the body to make it crossable by a guidewire, in a 2026 technique report. Their technique uses a five-to-eight-millimeter skin incision over the lesion, sited by ultrasound. Through it, a curved artery forceps is introduced without formally exposing the artery.
Under continuous X-ray guidance the forceps gently engages the calcified segment, redistributing stress within the calcium ring to crack its microstructure and restore some give. The team applied it in three patients with focal, heavily calcified anterior tibial occlusions that had resisted conventional approaches. After modulation, wires crossed in all three, balloon angioplasty restored inline flow, and no procedural complications occurred. At up to six months of follow-up every treated vessel remained patent and wounds had healed completely. The authors offer the maneuver as a bailout when everything else has failed.
Catalog record
| CREATOR | Karthigesu Aimanan, Michael Arvind, Putera Mas Pian, Hanif Hussein |
|---|---|
| YEAR | 2026 |
| COLLECTION | PAPERS |
| FORMAT | TXT |
| FILE SIZE | 13030 |
| LICENSE | https://creativecommons.org/licenses/by/4.0 |
| RIGHTS | CC BY |
| SOURCE | Europe PMC |