Efficacy of lacrosse NSE using the "leopard-crawl" technique on severely calcified lesions

Calcified lesions often encounter difficulties associated with stent delivery and underexpansion. Lesion preparation of calcified lesions prior to stent implantation is important to facilitate stent delivery and provide concentric stent expansion. The Lacrosse NSE, a balloon catheter with 3 nylon elements, provides an efficacious scoring effect when used for predilatation of calcified lesions. Although bench testing on a calcified model verified that Lacrosse NSE and other scoring catheters provide a greater scoring effect compared to conventional plain old balloon angioplasty, delivery to target lesion location using standard delivery techniques for severely calcified lesions is typically more problematic. One method for overcoming the obstacles faced by difficult delivery is use of the "leopard-crawl" technique. This technique uses a low inflation pressure to create a wedge into the calcification and then subsequently advances the catheter during balloon deflation to facilitate catheter delivery across the stenosis. This technique is well suited for the Lacrosse NSE due to the unique catheter design. We hereby report on the initial clinical use of the leopard-crawl technique for facilitating catheter delivery in cases of severely calcified lesions in which standard delivery was unsuccessful, while creating an efficacious scoring effect into the calcified lesion that reflects the results of bench testing.