[MO-11] Presentation Awards
Penetration method for severe calcified lesions using OTW balloon and microcatheter with strong back-up.
A-75-year-old man complained left intermittent claudication. Last year, diagnostic angiography revealed severe stenotic lesions in left SFA with severe calcified nodules, and subsequently endovascular treatment was performed. The lesions were not enough expanded in spite of using cutting balloon. The present case, angiography revealed two lesions, focal CTO lesion with severe calcification and severe stenotic lesion with nodular calcification, at the same site that we have treated last year. We considered that it is necessary to penetrate the center of both calcified lesions and to crush the bulky one to obtain the enough acute gain after stent implantation. We invested two penetration strategies. First, for the CTO lesion, we inflated the over the wire (OTW) balloon adjusted to the proximal vessel diameter in just proximal of the CTO lesion. This gave us strong back-up (this is so-called the “balloon anchor technique” or “centering balloon technique”) and made it easy to penetrate the center of the calcified CTO lesion. Second, for severe stenotic lesion with eccentric nodular calcification, we delivered the microcatheter to just proximal of the lesion, and trap it using the balloon to obtain the strong back-up. This also enabled easy penetration for the bulky calcified nodule. After performing POBA, we confirmed that the lesions were penetrated centrally and crushed sufficiently according to the IVUS. Finally, we deployed bare nitinol stent for such two lesions, and obtained enough acute gain. In this case, we experienced two different penetration strategies for severe and bulky calcified lesions. So, we report this case with our slight considerations.