Challenging Multisite Tibial Intervention Using XO Cross 14 Microcatheter in Coaxial Configuration

Purpose: Accessing stenosed lower-limb vasculature in peripheral arterial disease (PAD) and critical limb ischemia (CLI) patients requires low-profile catheters with long working lengths without sacrificing the ability to navigate to, and cross, lesions. Coaxial catheter systems provide additional push ability and control when crossing challenging lesions, but the standard tapered design of long microcatheters often prevents the use of a support catheter due to its profile.

Materials and Methods: The 2F XO Cross microcatheter (Transit Scientific) is a nontapered exoskeleton catheter that supports low-profile, triaxial catheter configurations as demonstrated in a complex case involving a PAD/CLI patient with a focal peroneal lesion spanning the tibioperoneal trunk and posterior tibial chronic total occlusion.

Results: The lesions were accessed using a triaxial catheter support system made up of a .014” guidewire, an XO Cross 14 microcatheter, and a 5F XO Cross 35 support catheter. The triaxial system was steered through the femoropopliteal artery to first cross the tibioperoneal trunk focal occlusion. The XO Cross was advanced next to the .014” guidewire with the guidewire holding the path of the occluded peroneal while the XO Cross was wirelessly steered to cross the occluded post-tibial lesion. A percutaneous transluminal angioplasty balloon was then advanced over the wire to treat the peroneal occlusion. The procedure resulted in the successful recanalization of both the peroneal and posterior tibial occlusions.

Conclusions: This case demonstrates the successful use of a triaxial catheter approach to navigate to and cross challenging lesions in both the peroneal and posterior tibial arteries during a singular procedure and thus a promising approach for treating below-the-knee lesions to preserve the lower limbs in PAD/CLI patients.