A percutaneous intravascular cracking (PICKING) with a TruePath™ for extremely calcified lesions

  • Shinya IkedaEmail author
  • Rei Fukuhara
  • Yuji Nishimoto
  • Ryoji Taniguchi
  • Yukihito Sato
Images in Cardiovascular Intervention

A PICKING technique: percutaneous intravascular cracking with a guidewire tail, which indicated longitudinal repeated cracking of the calcified lesion by a stiff tail of a guidewire with the parallel-wire method under fluoroscopy guidance, was previously reported to make balloon catheter delivery easier for severely calcified lesions [1, 2]. However, this technique might have some problems as follows: (1) a potential risk of vessel perforation mainly because of the poor fluoroscopic visibility of the guidewire tail; and (2) poor handling of its direction, etc.

A 74-year-old woman with intermittent claudication was referred to our hospital. Diagnostic angiography revealed extremely calcified chronic total occlusions (CTOs) in both ostial superficial femoral arteries (SFAs) (Fig.  1a). No stiff wire, such as a 100-g tip-load 0.014-in. guidewire, could pass the calcification retrogradely in the right SFA. Given a TruePath™ (Boston Scientific, Natick, Massachusetts), which consists of a...



We would like to express our gratitude to Mr. John Martin for his grammatical assistance.



Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

Video clip 1. Failure to cross the calcification with CROSSER™. The CROSSER™ could not cross the calcification, which made us to decide using The PICKING technique with a TruePath™. (MP4 6482 kb)

12928_2019_593_MOESM2_ESM.mp4 (5.8 mb)
Video clip 2. The PICKING technique with a TruePath™. The TruePath™ goes along the first wire and longitudinally cracked the underlying calcification. The TruePath™ has good fluoroscopic visibility and controllability. (MP4 5953 kb)


  1. 1.
    Kawarada O, Noguchi T, Yasuda S. Longitudinal cracking with a guidewire tail for extremely calcified lesions in infrainguinal arteries: PICKING technique. Cardiovasc Interv Radiol. 2018;41:313–6.CrossRefGoogle Scholar
  2. 2.
    Funabashi S, Kawarada O, Yagyu T, Noguchi T, Yasuda S. The PICKING technique for self–expanding nitinol stent expansion of an extremely calcified lesion in the femoropopliteal artery: the tail makes the difference. Cardiovasc Interv Ther. 2019;34:74–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Ichihashi S, Sato T, Iwakoshi S, Hirofumi I, Kimihiko K. Technique of percutaneous direct needle puncture of calcified plaque in the superficial femoral artery or tibial artery to facilitate balloon catheter passage and balloon dilation of calcified lesions. J Vasc Interv Radiol. 2014;25:784–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Nakabayashi K, Ando H, Kaneko N, Shiozaki M, Sunaga D, Matsui A, et al. A novel lesion crossing technique: balloon deployment using FORcible Manner (BADFORM) technique. Catheter Cardiovasc Interv. 2017;90:1161–5.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2019

Authors and Affiliations

  1. 1.Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan

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