Atherotomy Balloons
1. Cutting balloon angioplasty with Wolverine (Boston Scientific, Natick, MA)
- Cutting balloon: severs the elastic and fibrotic continuity of the vessel and cuts the continuity of the atheromatous plaque
- Indications: small vessels, bifurcation/ostial bifurcations/fibrotic lesions/mild to moderate calcified lesions/ in stent restenosis lesions
- Available diameters: 2mm-4mm (0.25mm increments)
- Lengths: 6mm, 10mm and 15mm lengths
- Nominal = 6atm, RBP = 12atm
- Avoid in thrombotic lesions in coronary spasms
- Choose 0.25 to 0.5mm less than treated vessel diameter
- After initial inflation, retract into guide and change the angle before re-advancing and doing another inflation
- If cutting balloon doesn’t pass through the lesion, do angioplasty with smaller size compliant balloon and then do cutting balloon angioplasty.
3. Cutting balloon angioplasty with Flextome (Boston Scientific, Natick, MA)
Atherotome comparison between Wolverine and Flextome
1. Scorning balloon angioplasty with Angiosculpt (AngioScore, Inc, Fremont, CA)
- Electropolished, helical scoring element safely scores lesion circumferentially.
- Rectangular edges provide a predictable dilatation resulting in low dissection rates and minimal device slippage.
- Nitinol-enhanced balloon deflation for excellent rewrap and recross capabilities.
- Large working range (2–20atm) allows device to be tailored to vessel size (Choose 0.5mm smaller size the treated vessel diameter).
- Nominal = 8atm, RBP = 16-20atm
- Available Diameters: 2-3.5mm (0.5mm increments)
- Lengths: 6mm, 10mm and 15mm
- Choose 1:1 balloon diameter
- Pre-dilatation with AngioSculpt yielded 33% – 50% greater luminal gain than direct stenting or pre-dilatation with a conventional angioplasty balloon.
4. Constrained Semi-compliant balloon angioplasty with Chocolate (TriReme Medical, Pleasanton, CA)
- The Chocolate PTA balloon is a semi-compliant balloon that is encased in a nitinol-constraining structure, or cage, that allows for 1:1 vessel sizing
- INFLATION: During inflation, the cage causes the balloon to form a series of segmented pillows and grooves along the entire lesion.
- BALLOON: Balloon is confined to the cage during inflation, preventing dog-boning and protecting healthy tissue.
- CAGE: Nitinol cage expands with balloon, protecting the vessel from torsional stresses and minimizing dissections.
- PILLOWS: The pillows apply force to create small dissections that are necessary for effective dilatation.
- GROOVES: The grooves relieve the stress and stop dissections from propagating.
If you do not have availability of the atherotomy balloons, you may consider double wiring the lesion with any work horse wire, and do angioplasty with NC balloon with second wire across the lesion. The second work horse wire may work as similar to atherotome of cutting balloon and may help cut the lesion (Poor man’s Atherotomy balloon)
