Procedure
A 7 Fr short sheath was placed in the right brachial artery. Angiography showed a defect from the axillary artery to the brachial artery. We attempted to penetrate the occluded lesion using a Vasallo Floppy 0.014-inch guidewire with the support of Prominent Raptor (1.8/2.6 Fr 70 cm). Initially, the approach seemed successful, but intravascular ultrasound (IVUS) showed that the wire was in the subintimal lumen. We placed a 7 Fr sheath in her left common femoral artery and passed a 0.014-inch Gladius (235 cm in length, Asahi Intecc Co., Ltd.) through the lesion using the antegrade approach. After confirmation by IVUS that the Gladius was in the true lumen, we extended the guidewire by using a 0.014-inch extension PV 165 cm in length (Asahi Intecc) and passed it through with the support of Guidezilla Ⅱ PV 7 Fr from her right brachial artery. After exchanging the guidewire with Vasallo 0.014-inch SUPPORT, we placed a self-expandable stent SMART Control 6.0 mm×150 mm and performed post-dilatation with a 5.0 mm×100 mm balloon catheter (Sterling MR 150 cm) (Figure3). After the procedure, remarkable distal flow was achieved, and the procedure was terminated without any complications. Numbness and impaired skilled movement in her right arm resolved after EVT.