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A modified directional atherectomy catheter for resection of calcified atherosclerotic plaques
M K Hong1, S C Wong, G S Mintz
1Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA.
Background:
The purpose of this study was to determine the feasibility of resecting calcified atherosclerotic plaques in human cadaveric vessels by using a modified directional coronary atherectomy catheter and to correlate these results with bench tests using an in-vitro sea coral model.
Methods:
The conventional directional coronary atherectomy catheter was modified by changing the cutter blade to a tungsten carbide material and by increasing the torsional strength of the drive cable. The performance of the modified directional coronary atherectomy (DCA) catheter was compared with the conventional catheter using a sea coral model to simulate calcified material. Then, 10 human ex-vivo arteries (eight with calcification) were treated with both conventional and modified catheters, and the results studied with intravascular ultrasound and confirmed by histologic examination.
Results:
Using the modified directional coronary atherectomy catheter it was possible to perform effective and consistent longitudinal cutting, and to resect a significantly larger amount of coral (1.0 +/- 0.1 mm2 versus 0.2 +/- 0.1 mm2 with conventional cutter, P < 0.0001). In heavily calcified ex-vivo arteries, the modified catheter was more effective in removing calcified plaques (13 +/- 11 mg versus 3.7 +/- 1.4 mg with conventional cutter, P = 0.07). Intravascular ultrasound confirmed the effective atherectomy (residual area stenosis 28 +/- 16% versus 47 +/- 10% with the conventional device, P < 0.05), and histologic examination showed calcified nodules in the atherectomy samples obtained with the modified cutter (area of calcium 1.43 +/- 0.89 mm2 versus 0.93 +/- 0.83 mm2 with the conventional cutter).
Conclusions:
The modified directional coronary atherectomy catheter effectively removed both non-calcified and calcified plaques in the ex-vivo human cadaveric arteries, thus demonstrating the feasibility of directional coronary atherectomy of calcified plaques. This modified device shows promise for treating calcified coronary lesions, especially in larger vessels.
Insights
A modified directional coronary atherectomy catheter effectively removed calcified plaques in human arteries. This novel device shows promise for treating calcified coronary lesions, especially in larger vessels.
Area of Science:
- Cardiovascular Interventions
- Medical Device Engineering
- Atherosclerosis Research
Background:
- Atherosclerotic plaques, particularly calcified ones, pose challenges in cardiovascular interventions.
- Current atherectomy devices may have limitations in effectively resecting calcified material.
Purpose of the Study:
- To assess the feasibility of resecting calcified atherosclerotic plaques using a modified directional coronary atherectomy (DCA) catheter.
- To compare the performance of the modified DCA catheter against a conventional one in simulated and ex-vivo models.
Main Methods:
- A conventional DCA catheter was modified with a tungsten carbide blade and enhanced drive cable strength.
- Performance was evaluated using an in-vitro sea coral model and ex-vivo human arteries with calcification.
- Intravascular ultrasound and histologic examination confirmed atherectomy effectiveness.
Main Results:
- The modified DCA catheter resected significantly more simulated calcified material (coral) than the conventional catheter.
- It demonstrated greater effectiveness in removing calcified plaques from ex-vivo human arteries.
- Intravascular ultrasound showed reduced residual stenosis with the modified device compared to the conventional one.
Conclusions:
- The modified DCA catheter successfully resected both calcified and non-calcified plaques in ex-vivo human arteries.
- This modification proves the feasibility of directional coronary atherectomy for calcified plaques.
- The enhanced catheter holds potential for treating calcified coronary lesions, particularly in larger vessels.