ArticleCVIR endovascular2025
FRAP-CROSS technique: Fracking and Rendezvous-PIERCE for intracalcium crossing in femoropopliteal diffuse calcified occlusions.
Article in CVIR endovascular, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Clinical efficacy and safety of the Jetstream Atherectomy System in Chinese Patients with femoropopliteal artery occlusive disease.CVIR endovascular · 2026Article
- Advanced Needle-Based Strategies for Complex Calcified Peripheral Artery Disease: A Systematic Review.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Review
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundFemoropopliteal diffuse calcified occlusions (FPDCOs) are challenging, especially in high-bleeding-risk patients for whom a stentless strategy is preferred. We introduce FRAP-CROSS, combining Fracking and Rendezvous-PIERCE, to achieve intracalcium guidewire crossing and facilitate stentless revascularization. MATERIALS AND
methodsWhen bidirectional intracalcium wiring fails across dense calcification in FPDCO, FRAP-CROSS is applied. Fracking is initially performed by inserting a 20-gauge metal needle into a guidewire-uncrossable plaque and applying hydraulic pressure to create microfractures, facilitating subsequent guidewire crossing. If device tracking remains unsuccessful after guidewire passage, Rendezvous-PIERCE is employed. An 18-gauge needle is advanced toward the intralesional guidewire tip, and the guidewire is externalized through the needle (Needle Rendezvous). A 20-gauge needle is then advanced over the externalized guidewire to create a lumen within the calcification (inner PIERCE). After successful all-intracalcium crossing, balloon angioplasty is performed. Inadequate expansion prompts additional Fracking alone or with Jetstream atherectomy (JET-Frack). Drug-coated balloon (DCB) angioplasty completes the stentless strategy.
resultsA 90-year-old man at high bleeding risk with bilateral FPDCOs underwent FRAP-CROSS. The right limb required three Fracking and two Rendezvous-PIERCE; the left required four Fracking and two Rendezvous-PIERCE, respectively, with adjunctive JET-Frack. Following DCB-based stentless treatment, final angiography and intravascular ultrasound confirmed adequate luminal expansion and blood flow in both limbs, without major complications.
conclusionFRAP-CROSS provides a practical approach to achieve all-intracalcium guidewire crossing and stentless revascularization in complex FPDCOs. Further studies should assess its safety and long-term outcomes.
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