Percutaneous Reconstruction of Interrupted Aortic Arch

The plan was to cross the interrupted segment retrograde. An Asahi Confianza Pro guidewire crossed into a false tract (figure 2, figure 3). Reshaping the guidewire by changing the angle of primary bend and length to find a true lumen and using multiple angiographic views, the guidewire finally crossed into the true lumen (figure 4). The true lumen was confirmed by passing a 1.8F microcatheter and injecting contrast through the total occlusion segment into aortic arch. A 4mm diameter coronary balloon was used to predilate the lesion(figure 5) ) followed by a guiding catheter contrast injection to assess if any dissection or perforation occurred (figure 6). A self-expandable (28mm diameter x 40mm length) non-covered stent (figure 7) was implanted in an attempt to avoid use or a covered stent since the occlusion waste near a large left subclavian artery. Afterwards balloon dilation was performed at 12mm and then 18mm diameters (figure 8, figure 9). Final angiography showed good angiographic results and zero pressure gradient with no dissection (figure 10).