[MO-54] Dose angioscopy change our strategy? (Three cases of endovascular treatment for a superficial femoral artery with high-resolution angioscopic imaging catheter.)
【Objectives】After the approval of drug-coated balloon (DCB) for superficial femoral artery (SFA), evaluation of dissection - usually by angiography or intravascular imaging devices such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) - after plain old balloon angioplasty (POBA) is becoming more crucial than ever before. We have done three cases of endovascular treatment for SFA lesions with high-resolution angioscopic imaging catheter which may give us further information than angiography or other intravascular imaging devices.
【Methods and Results】
Case 1: A 72-year-old female was treated for a restenotic lesion 6 months after POBA. As angiography and angioscopy revealed a minor dissection after dilatation by scoring and non-compliant balloon, we used DCB for the lesion.
Case 2: A 78-year-old male was treated for a de novo stenotic lesion. After balloon dilatation, angiography and angioscopy showed a major dissection even after repeated long-time balloon inflation. So we decided to implant a bare metal self-expanding stent for the lesion instead of DCB.
Case 3: A 83-year-old female complained recurrence of intermittent claudication 6 months after bare metal self-expanding stent implantation. In-stent occlusion (ISO) was observed by angiography. With angioscopy, we could confirm that neointimal hyperplasia induced ISO and there was no thrombus inside the lesion. After scoring balloon dilatation, we treated the lesion with DCB.
【Conclusions】
Angioscopy capable of viewing forward direction can detect thrombus or plaque protrusion after stenting same as imaging devices including IVUS and OCT. Moreover it can provide us with three-dimensional information about dissection after balloon dilatation. Angioscopy might have the potential to change our interventional strategy in SFA lesions.
【Methods and Results】
Case 1: A 72-year-old female was treated for a restenotic lesion 6 months after POBA. As angiography and angioscopy revealed a minor dissection after dilatation by scoring and non-compliant balloon, we used DCB for the lesion.
Case 2: A 78-year-old male was treated for a de novo stenotic lesion. After balloon dilatation, angiography and angioscopy showed a major dissection even after repeated long-time balloon inflation. So we decided to implant a bare metal self-expanding stent for the lesion instead of DCB.
Case 3: A 83-year-old female complained recurrence of intermittent claudication 6 months after bare metal self-expanding stent implantation. In-stent occlusion (ISO) was observed by angiography. With angioscopy, we could confirm that neointimal hyperplasia induced ISO and there was no thrombus inside the lesion. After scoring balloon dilatation, we treated the lesion with DCB.
【Conclusions】
Angioscopy capable of viewing forward direction can detect thrombus or plaque protrusion after stenting same as imaging devices including IVUS and OCT. Moreover it can provide us with three-dimensional information about dissection after balloon dilatation. Angioscopy might have the potential to change our interventional strategy in SFA lesions.