Pulsatile Intravascular Lithotripsy: A Novel Mechanism for Peripheral Artery Calcium Fragmentation and Luminal Expansion

Virmani, Renu; Finn, Aloke V.; Kutyna, Matthew; Sato, Yu; Meess, Karen; Smith, Cody J.; Chisena, Robert S.; Gurm, Hitinder S.; George, Jon C.

doi:10.1016/j.carrev.2023.01.003

Cited by 4 publications

(2 citation statements)

References 32 publications

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“…Also, it is still unknown whether different sodium types of EDTA affect the calcium in the atherosclerotic lesion. Micro‐computed tomography (micro‐CT) is an imaging tool with μm‐level resolution and we have previously reported the efficacy of micro‐CT in evaluating calcified lesions 7,12,13 . The purpose of this study was to evaluate the feasibility of two types of EDTA (2Na‐ and 3Na‐H 2 O) administration using the porous balloon delivery to evaluate its effect on cadaveric atherosclerotic below‐the‐knee (BTK) calcified lesions using micro‐CT.…”

Section: Introductionmentioning

confidence: 99%

Effect of EDTA with porous balloon on calcified lesion: An atherosclerotic cadaver study

Kawai,

Madra,

Kawakami

et al. 2024

Cathet Cardio Intervent

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BackgroundEthylene diamine tetra‐acetic acid (EDTA) is a chelating agent used to dissolve calcium deposits but evidence in decalcifying atherosclerotic lesions is limited.AimsWe assessed the feasibility and efficacy of EDTA delivered via porous balloon to target calcified lesions in cadaveric below‐the‐knee (BTK) arteries.MethodsUsing porcine carotid arteries, EDTA concentration was measured in the arterial wall and outside the artery at the 0‐, 0.5‐, 4‐, and 24‐h circulation after the injection through a porous balloon. In cadaver BTK samples, the proximal and distal anterior tibial artery (ATA) and distal posterior tibial artery (PTA) were studied. EDTA‐2Na/H2O or EDTA‐3Na/H2O were administrated using a porous balloon, then circulated for 6 h for EDTA‐3Na/H2O and 24 h for EDTA‐2Na/H2O and EDTA‐3Na/H2O. Micro‐CT imaging of the artery segments before and after the circulation and cross‐sectional analyses were performed to evaluate calcium burden.ResultsIn the porcine carotid study, EDTA was delivered through a porous balloon present in the arterial wall and was retained there for 24 h. In BTK arteries, cross‐sectional analyses of micro‐CT revealed a significant decrease in the calcium area in the distal ATA segment under 24‐h circulation with EDTA‐2Na/H2O and in the distal ATA segment under 24‐h circulation with EDTA‐3Na/H2O. The proximal ATA segment under 6‐h circulation with EDTA‐3Na/H2O showed no significant change in any parameters of calciumConclusionEDTA‐3Na/H2O or EDTA‐2Na/H2O with longer circulation times resulted in greater calcium reduction in atherosclerotic lesion. EDTA may have a potential therapeutic option for the treatment of atherosclerotic calcified lesions.

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Section: Introductionmentioning

confidence: 99%

Effect of EDTA with porous balloon on calcified lesion: An atherosclerotic cadaver study

Kawai,

Madra,

Kawakami

et al. 2024

Cathet Cardio Intervent

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“…Energy-based intravascular lithotripsy (IVL) for calcium disruption are limited in only producing several isolated linear or circumferential cracks in calcium plates. 2,3 Currently, no energy-IVL approach can treat calcium more extensively than creating isolated cracks. Combination therapy could be investigated to determine whether EDTA treatment via a porous balloon in combination with IVL may improve therapeutic results.…”

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confidence: 99%

Can ethylene diamine tetra‐acetic acid improve calcium fracture when combined with intravascular lithotripsy?

Gruslova,

Feldman

2024

Cathet Cardio Intervent

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Key points Agents which dissolve hydroxyapatite may synergize with intravascular lithotripsy (IVL) to treat calcium plates more extensively, facilitating greater penetration of drug‐coated balloons delivered agents and maintain gain in lumen area without stenting. Dissolving hydroxyapatite could potentially allow more frequent use of high‐pressure balloons without IVL or atherectomy to fracture calcium plates, offering a lower cost approach. Other mechanisms such as debonding between calcium plate and fibrous tissue junctions may also be enhanced with IVL and calcium‐modifying agents to improve calcified vessel compliance.

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Technical note: Improving orbital atherectomy efficacy for calcified nodules using a curved guide catheter

Iiya,

Kobayashi,

Onishi

2024

Vascular

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Objectives Endovascular therapy (EVT) for calcified nodules in patients with peripheral artery disease (PAD) remains challenging in achieving favorable outcomes. This study aims to investigate the effectiveness of orbital atherectomy (OA) for calcified nodules using an IM catheter to precisely control the device and achieve optimal engagement with the target lesion. Methods We performed EVT for a calcified nodule in the right common femoral artery using an OA. Due to the large vessel size, controlling the OA to effectively engage the lesion was challenging. To overcome this, we utilized an IM catheter to guide the OA toward the target lesion. Results The use of the IM catheter successfully directed the OA to the calcified lesion, resulting in significant lumen enlargement. The procedure was completed without any complications, and the OA achieved effective debulking of the calcified nodule. Conclusions The combination of OA and IM catheter facilitated effective contact with the target lesion, improving the performance of the debulking device. This approach may enhance the management of calcified lesions in large-diameter arteries during EVT, potentially leading to better clinical outcomes.

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Pulsatile Intravascular Lithotripsy: A Novel Mechanism for Peripheral Artery Calcium Fragmentation and Luminal Expansion

Cited by 4 publications

References 32 publications

Effect of EDTA with porous balloon on calcified lesion: An atherosclerotic cadaver study

Effect of EDTA with porous balloon on calcified lesion: An atherosclerotic cadaver study

Can ethylene diamine tetra‐acetic acid improve calcium fracture when combined with intravascular lithotripsy?

Technical note: Improving orbital atherectomy efficacy for calcified nodules using a curved guide catheter

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