Abstract Background The optimal endovascular treatment (EVT) for chronic total occlusion (CTO) lesions in patients with peripheral artery disease (PAD) has remained unestablished.We bolia outlet gent encountered a patient with PAD in whom CTO was successfully treated using a novel technique that involved intravascular ultrasound (IVUS) and angled guiding catheter: IVUS Preceding with Angled guiDing catheter (I-PAD) technique.Case presentation A 74-year-old male presented with intermittent claudication attributed to CTO of the right external iliac artery.EVT was performed via the right common femoral artery.We retrogradely advanced the I-PAD system (i.
e.partially extending the IVUS transducer portion from the tip of the angled guiding catheter) in the CTO lesion under the real-time guidance of IVUS imaging.We successfully traversed the CTO lesion without the use of a guidewire in approximately three minutes.The keychron m4 procedure concluded successfully without any procedure-related complications, following optimal stenting.Conclusions The I-PAD might be an effective technique to accurately, quickly, and safely pass through CTO lesions.