Microchannel-Guided Revascularization of Tibial Chronic Total Occlusions Using a 0.009-Inch Tapered-Tip Guidewire

We describe the use of a 0.009-inch tapered-tip guidewire to achieve successful revascularization of tibial chronic total occlusions in a patient with chronic limb-threatening ischemia initially referred for major amputation. Initial revascularization attempts using multiple non-tapered 0.014-inch and 0.018-inch guidewires were unsuccessful. Subsequent use of 0.009-inch and 0.010-inch tapered-tip guidewires enabled intraluminal crossing of the tibioperoneal trunk, posterior tibial, and peroneal artery CTOs, followed by angioplasty and restoration of in-line flow. This case highlights the feasibility of leveraging microchannels within peripheral CTOs using tapered-tip guidewires to achieve successful revascularization and limb salvage.