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Three-dimensional visualization of scoring mechanism of 'AngioSculpt' balloon for calcified coronary lesions using
Takashi Kanai1, Takafumi Hiro1, Tadateru Takayama1
1Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Insights
AngioSculpt Scoring Balloon Catheter effectively treats severe calcified coronary lesions by creating scoring marks. This method aids in successful stent implantation, offering a new option for complex cases.
Area of Science:
- Interventional Cardiology
- Medical Devices
- Cardiovascular Imaging
Background:
- Plaque calcification remains a significant challenge in coronary interventional cardiology, hindering effective stent expansion.
- The AngioSculpt Scoring Balloon Catheter is designed to create scoring marks, aiming to prevent plaque shift and balloon slippage during procedures.
Observation:
- This study applied the AngioSculpt device to a patient with severe calcification in the left circumflex coronary artery.
- High-pressure predilatation with AngioSculpt facilitated successful stent implantation in the treated lesion.
Findings:
- Three-dimensional optical coherence tomography (3-D OCT) visualized radial scores created by AngioSculpt's nitinol wires.
- These spiral indents were observed at weak points adjacent to calcification, enabling less traumatic dilatation.
- While effective, the scoring marks were not clearly visualized with intravascular ultrasound.
Implications:
- AngioSculpt demonstrates potential as a viable option for managing severe calcified coronary lesions.
- The device's mechanism of action, involving targeted scoring, may improve outcomes in complex interventional cardiology cases.
- Further research and clinical validation are warranted to establish AngioSculpt's role in treating calcified lesions.
Abstract:
Despite developments in coronary interventional cardiology, plaque calcification is a critical issue of stent expansion. AngioSculpt Scoring Balloon Catheter® (AngioSculpt; AngioScore Inc., Fremont, CA, USA) can produce more 'scoring' marks, which leads to prevention of 'plaque shift' and 'balloon slippage'; moreover, the 'scoring' produces some cutting effect, leading to successful stent implantation even on severe calcified lesions. We have applied AngioSculpt on severe calcified lesions to achieve its adequate expansion, and report the mechanism of the 'scoring' and its efficacy evaluated by three-dimensional stereoscopic reconstruction (3-D) of optical coherence tomography (OCT; LightLab Imaging, Inc., Westford, MA, USA). The patient is a 64-year-old male, who had diffuse stenosis in the left circumflex coronary artery (LCX) with severe calcifications, and was treated using AngioSculpt. AngioSculpt predilatation with a high pressure led to successful stent implantation. The radial scores were clearly imaged by 3-D OCT, demonstrating that radial nitinol wires made spiral indents from the relative weak points at the surface adjacent to calcification, which resulted in a less traumatic and safe dilatation although the scoring mark was not recognized clearly in intravascular ultrasound. This report suggests AngioSculpt might become one of the options for a severe calcified lesion.