[MO-57] The Feasibility of a Novel Technique Using Endoscopic Biopsy Forceps for Calcified Plaques of Femoropopliteal lesion
Severe calcification limits EVT efficacy in the drug eluting era because of reducing vessel compliance and tissue permeability for drugs. Atherectomy devices are effective tools for calcified lesions but are not available in current Japanese clinical setting. We report the new debulking method using endoscopic biopsy forceps (Radial Jaw, Boston Scientific Corporation) to remove calcified plaques. Radial Jaw forceps is compatible to 6Fr sheath and able to remove tissue in the tangential direction with swing function. We attempted this method for 4 femoropopliteal lesions with severe calcification including chronic total occlusion (CTO) 2 (TASCⅡ B lesion:1 case, C lesion:2 cases, D lesion:1 case; PACSS grade 2:1 case,grade 4:3 cases). Six Fr. Destination guide-sheath (TERUMO) was inserted from ipsilateral femoral artery in 3 cases and contralateral femoral artery in one case. The target lesions were pre-dilated by 4mm sized balloon to create working space of the forceps. Then, we advanced the forceps into the lesions to remove the calcified plaques under fluoroscopy. The endpoint of debulking was residual stenosis less than 70%. We could remove the calcified plaques in all cases without vascular perforation despite subclinical distal embolism occurred in one case. All lesions were well responded by conventional balloon angioplasty, but stent deployment was performed in one case because of long CTO. This debulking method contributed to effective vessel preparation for femoropopliteal lesions with severe calcification. Although Radial Jaw cannot be reimbursed in Japanese public insurance, it is much cheaper (2000 yen) compared to existing atherectomy devices.