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Intravascular Ultrasound for Molecular Imaging
Published in Robert J. Gropler, David K. Glover, Albert J. Sinusas, Heinrich Taegtmeyer, Cardiovascular Molecular Imaging, 2007
Other common interventional procedures include atherectomy, brachytherapy, and coronary bypass surgery. Atherectomy uses a small rotating blade on the tip of a catheter to disrupt plaque and collect debris with a suction tube. It is usually reserved for calcified plaques resistant to angioplasty or stent procedures (14), but it has the risk of vessel rupture or injury. Another interventional treatment is brachytherapy. It delivers focused radiation at the lesion site using a catheter, preferentially killing plaque cells. In more severe cases in which angioplasty or stent procedures are ineffective, coronary bypass surgery is required. Vessels are usually grafted from extremities to provide collateral flow around coronary occlusions. This surgical procedure requires a thorocotomy to gain access to the heart.
Safety and efficacy of paclitaxel drug-coated balloon in femoropopliteal in-stent restenosis
Published in Expert Review of Medical Devices, 2020
Mahesh Anantha-Narayanan, Keith Love, Sameer Nagpal, Azfar Bilal Sheikh, Christopher J. Regan, Carlos Mena-Hurtado
With increasing operator experience and with the availability of low profile devices, endovascular approaches are being used with increasing frequency among patients with FP disease [3]. Endovascular treatment options include plain balloon angioplasty (POBA), drug-coated balloon angioplasty (DCB), atherectomy, and stenting. For complex lesions refractory to balloon angioplasty (defined as highly calcified plaques, ulceration, and long-segment stenosis >150 mm), stenting has become a more attractive treatment modality [4,5]. The use of stents in complex lesions, however, has been complicated by high rates of one-year in-stent restenosis (ISR). The development of self-expanding nitinol stents improved rates of restenosis yet they remain as high as 40%-65% for nitinol stents [6,7].
Device profile of the FLEX Vessel Prep System for the treatment of peripheral arterial disease: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2022
Thomas Zeller, Tanja Böhme, Ulrich Beschorner, Elias Noory
Millions of individuals with PAD in the lower extremities are eligible for PTA procedures each year. However, the recognized underperformance of plain balloon angioplasty resulted in the rise of vessel preparation techniques through plaque modification or debulking prior to PTA to improve vessel compliance and to minimize the risk of dissection. Vessel preparation was initially established with specialty angioplasty balloons that incorporated cutting or scoring elements to create controlled dissections upon focal force of balloon inflation. In addition, specialty balloons were introduced to treat areas of stenosis where a stent was deemed inappropriate, ie. near bifurcations or in segments with significant flexion such as behind the knee. In the case of the cutting balloon, the fixed stiff blades limit balloon length to 20 mm – best used in short lesions. Subsequent products have a blunt wire cage on the outside of the balloon and are produced in a number of fixed lengths and diameters. The wires direct focal force to the lesion at specific contact points as the balloon is inflated. While specialty balloons have a place in the angioplasty armamentarium, atherectomy (directional, rotational, orbital, laser) is a vessel preparation method that is intended to provide lumen gain by removing (debulking) the plaque through cutting, shaving, grinding, or vaporizing. The major limitations of atherectomy revolves around inconsistent plaque removal and the inability to limit cutting depth. Because of this, adverse events of perforation and embolization are not uncommon. Recently, intravascular lithotripsy (IVL) has been introduced to modify plaque in calcified lesions by using shock waves to create microfractures or microfissures via energy absorption in the calcium. Although each approach has a unique mechanism of action, they have limitations in their utilization with long, complex PAD lesions and only PTA and specialty balloons are typically used in stenosed AV fistulae and grafts (see Section 4.0 and Table 1). Long, complex, mixed morphology lesions are estimated to be present in up to 50% of PAD patients treated with PTA depending on anatomical lesion location. These lesions are more challenging to treat and are associated with higher rates of acute complication and poorer long-term clinical outcomes [10].