Maximizing Lumen Gain With Directional Atherectomy.
OBJECTIVE
To describe the use of a low-pressure balloon inflation (LPBI) technique to delineate intraluminal plaque and guide directional atherectomy in order to maximize lumen gain and achieve procedure success.


METHODS
The technique is illustrated in a 77-year-old man with claudication who underwent superficial femoral artery revascularization using a HawkOne directional atherectomy catheter. A standard angioplasty balloon was inflated to 1 to 2 atm during live fluoroscopy to create a 3-dimensional "lumenogram" of the target lesion. Directional atherectomy was performed only where plaque impinged on the balloon at a specific fluoroscopic orientation. The results of the LPBI technique were corroborated with multimodality diagnostic imaging, including digital subtraction angiography, intravascular ultrasound, and intra-arterial pressure measurements.


CONCLUSIONS
With the LPBI technique, directional atherectomy can routinely achieve <10% residual stenosis, as illustrated in this case, thereby broadly supporting a no-stent approach to lower extremity endovascular revascularization.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA gstanley@umc.edu.
Gregory A
GA
Stanley
Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
John G
JG
Winscott
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D062186:Arterial Pressure; D017073:Atherectomy / Q000379:methods*; D003251:Constriction, Pathologic; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D064847:Multimodal Imaging; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency
atherectomy; balloon angioplasty; claudication; critical limb ischemia; intravascular ultrasound; limb salvage; peripheral artery disease; residual stenosis; revascularization