{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:08:22Z","timestamp":1778825302683,"version":"3.51.4"},"reference-count":10,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Endovascular treatment (EVT) for chronic total occlusion (CTO) lesions has progressed recently; however, severely calcified lesions remain difficult to treat owing to challenges in guidewire passage and limited balloon or stent expansion. We report the case of a 79\u2010year\u2010old Asian male with intermittent claudication who had previously undergone bare metal stent (BMS) implantation for CTO of the left superficial femoral artery (SFA). He underwent open surgical repair with end\u2010to\u2010end anastomosis of the left common femoral arter (CFA) to treat a puncture\u2010site perforation. However, a chronic left CFA aneurysm later developed despite the initial repair. Angiography revealed a completely occluded SFA with a severely calcified plaque distal to the BMS. We selected a retrograde approach to perform EVT for the CTO of the left SFA via the popliteal artery, to avoid the ipsilateral antegrade approach crossing the aneurysm. As the puncture site was near the lesion, a direct puncture of the plaque was performed from the inserted sheath using a percutaneous transcholangiography (PTC) needle (calc\u2010pick technique). The implanted BMS and calcification were useful as markers for needle insertion. To confirm the direction, we advanced the needle into the calcified occlusion and introduced a 0.014\u2010in. wire toward the distal true lumen. After the wire position was confirmed using intravascular ultrasonography, step\u2010by\u2010step balloon dilatation was performed. A drug\u2010coated balloon was used to finalize the procedure, resulting in good forward flow without any complications. Therefore, direct puncture of a severely calcified plaque with a PTC needle is a useful and safe EVT strategy if the lesion is close to the puncture site.<\/jats:p>","DOI":"10.1002\/ccd.70523","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:46:00Z","timestamp":1771479960000},"page":"1687-1691","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct Puncture of Calcified Plaque Using a Percutaneous Transcholangiography Needle in Endovascular Treatment for Superficial Femoral Artery Chronic Total Occlusion: A Case Report"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9292-6600","authenticated-orcid":false,"given":"Kosei","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Nippon Medical School Musashi\u2010Kosugi Hospital  Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6112-104X","authenticated-orcid":false,"given":"Yusuke","family":"Hosokawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Nippon Medical School Musashi\u2010Kosugi Hospital  Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5825-3663","authenticated-orcid":false,"given":"Toshinori","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Nippon Medical School Musashi\u2010Kosugi Hospital  Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3469-2167","authenticated-orcid":false,"given":"Kuniya","family":"Asai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae179"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25387"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1583\/10-3248.1"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42155-021-00263-1"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00380-019-01498-8"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12928-016-0444-7"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22607"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/15266028211057091"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2014.01.016"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29255"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70523","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70523","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70523","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:18:54Z","timestamp":1778822334000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":10,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/ccd.70523"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70523","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]},"assertion":[{"value":"2025-06-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}