Stent implantation and optical frequency domain imaging with carbon dioxide for chronic total occlusion in the superficial femoral artery

A 68-year-old female was presented with claudication in the left lower leg. She underwent angiography with carbon dioxide (CO₂) because she had a history of anaphylactic shock to iodinated contrast medium. It revealed total occlusion of the left superficial femoral artery (SFA), and subsequently endovascular therapy (EVT) was performed by an antegrade approach from the left common femoral artery. After stent implantation, we performed optical frequency domain imaging (OFDI) using CO₂ as contrast medium. OFDI has been extensively studied in the coronary circulation; however, its use in the peripheral arterial circulation is scarce. We present a case of stent implantation and OFDI using CO₂ as an ancillary tool during EVT for SFA lesions in the patient with contraindication to iodinated contrast medium.