Orbital atherectomy as an adjunct to debulk difficult calcified lesions prior to mesenteric artery stenting.
OBJECTIVE
To describe a technique in which percutaneous orbital atherectomy is used to debulk heavily calcified superior mesenteric artery (SMA) occlusions as an adjunct in patients undergoing angioplasty and stenting.


METHODS
The technique is demonstrated in a 62-year-old woman with a replaced right hepatic artery originating from an SMA occluded by densely calcified lesions. Via a left transbrachial approach, a 7-F MPA guide catheter was used to engage the ostium of the SMA, which was crossed using a catheter and guidewire. The calcified lesion was debulked using the 2-mm Diamondback 360° orbital atherectomy system. The wire was exchanged for a 0.014-inch filter wire and 0.018-inch guidewire. Using a 2-guidewire technique, the SMA was stented with a self-expanding stent for the distal lesion that crossed side branches and a balloon-expandable stent at the ostium. A 0.014-inch guidewire was placed into the replaced hepatic artery through a cell of the self-expanding stent, followed by deployment of a small balloon-expandable stent to address the residual lesion.


CONCLUSIONS
The use of orbital atherectomy to debulk occluded and heavily calcified SMA lesions may optimize the technical results with angioplasty and stenting.
Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN 55905, USA.
Jesse M
JM
Manunga
Gustavo S
GS
Oderich
D000800:Angioplasty, Balloon / Q000295:instrumentation; D017073:Atherectomy / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D006801:Humans; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000628:therapy*