Prolonged Inflation Technique Using a Scoring Balloon for Severe Calcified Lesion

Abstract

SummaryPercutaneous coronary intervention for the treatment of a severe calcified lesion is still one of the most technically challenging areas of interventional cardiology. Calcified lesions are a cause of stent underexpansion, which significantly increases the subsequent risks of in-stent restenosis and thrombosis, even when drug-eluting stents are used. In this report, we describe the usefulness of prolonged inflations using a scoring balloon catheter (Scoreflex) for severe calcified lesions. Prolonged inflation using a scoring balloon enables an adequate dilation for treatment of a severe calcified plaque that was unresponsive to conventional technique with or without rotational atherectomy.(Int Heart J 2017; 58: 982-987) Key words: Calcified plaque and indentation, Scoreflex T he use of drug-eluting stents (DESs) reduces the risks of repeat revascularization without an increase in death and myocardial infarction compared with the standard bare-metal stents. However, the risk of in-stent restenosis and stent thrombosis (ST) after DES implantation still remains.Percutaneous coronary intervention (PCI) for the treatment of a severe calcified lesion is still one of the most technically challenging areas of interventional cardiology.

Contemporary Approach to Heavily Calcified Coronary Lesions

“…[46] Otsuka et al reported a case series where prolonged inflation of the Scoreflex balloon allowed adequate dilation of severe calcified plaques as shown by the ‘creep phenomenon’, whereby prolonged inflation of the balloon produces a distortion force capable of expanding a resistant calcified lesion. [47] Scoring balloons have been considered by cardiologists as an alternative to cutting balloons and, in recent years, have been preferred because of major flexibility and deliverability, although no specific randomised control trials are reported in the literature.…”

Contemporary Management of Severely Calcified Coronary Lesions

“…In a feasibility trial of 60 patients, the AngioSculpt (Philips, San Diego, CA, USA) balloon showed a high procedural success rate with no serious procedural complications, confirming its technical feasibility and safety when applied to de novo or ISR coronary lesions prior to delivering DES [ 49 ]. Although scoring balloons were not initially intended for severe coronary calcification, preliminary experience has revealed their practicability for use during PCI [ 50 , 51 , 52 ]. In one study, scoring BA led to successful calcium modification of severely calcified lesions in 68%, although there was no control group in this study [ 53 ].…”

Contemporary tools and devices for coronary calcium modification

“…This postulated "creep phenomenon" is thought to be due to longitudinal forces that occur in the vessel wall under a prolonged sustained load. 13 The Non Slip Elements (NSE) alpha (B Braun, Melsungen, Germany) (previously known as Lacrosse NSE), is a balloon with three nylon scoring elements with a triangular cross section that are embedded in the balloon folds to create a smaller crossing profile. The balloon can be delivered using the "leopard-crawl" technique, creating a wedge into the calcified plaque with a low pressure inflation, then creeping forward during balloon deflation, allowing delivery across severe lesions.…”