New endovascular technique for thrombus in the non-stenting zone-the Grab a Clot and Hold ON "(GACHON) technique": Case report.

It is difficult to treat a thrombotic embolism in the common femoral artery or popliteal artery (POP A), i.e., the non-stenting zone. We report a new technique for the treatment of thrombotic embolism in the non-stenting zone using a self-expandable nitinol stent. Case 1 had an external iliac artery (EIA) occlusion that occurred over several months. A self-expandable nitinol stent was placed in the right EIA lesion via a retrograde approach using a distal 9-Fr balloon protection guide catheter in the right femoral artery. A thrombotic embolism occurred at the balloon protection site. It was too big to be removed using an aspiration catheter; therefore, we attempted removal with a self-expandable stent. Using a crossover approach, we delivered a nitinol self-expandable stent to the distal site of the thrombus, opened the tip of the stent, and pulled it up to the proximal site. Finally, we "grabbed a clot," moved it to the stenting zone, and "held on" the vessel wall without occurrence of a distal embolism. We named this the "GACHON technique." Case 2 underwent endovascular therapy for an acute thrombotic embolism in POP A after thoracic endovascular aortic repair for dissection. This thrombus was too big to aspirate, and we successfully treated it using the "GACHON technique." The "GACHON technique" may be considered as a choice of treatment for a thrombotic embolism in the non-stenting zone.