By Kazuhiro Ashida, MD, PhD
Heavily calcified plaque often requires the use of plaque modification prior to stenting to achieve optimal results. Typically, this is performed via use of a Rotablator system. However, Rotablation requires specific techniques and specialty wires, and also comes with certain potential complications. Furthermore, both experience and additional costs are also necessary. As the fundamental testing outlined in the publication identifies, plaque modification and creating a cracking effect via use of scoring balloon is an effective treatment approach for calcified lesions. Unfortunately, difficulty associated with delivery of such devices that are effective in achieving a cracking effect, such as Lacrosse NSE and cutting balloon, are sometimes experienced in a clinical setting. The unique design of the Lacrosse NSE complements the “Leopard-Crawl” delivery technique outlined and allows for successful delivery in a majority of severely calcified lesions. Feasible using a 6 Fr radial approach, utilizing a generic method that is comparatively easy to perform, as well as being a low cost technique given that it only requires a single balloon, the leopard-crawl technique can potentially be used in place of a number of cases, whereby Rotablator would be typically used to create plaque modification.
Recently, much attention has been focused on the plaque modification effect of scoring devices in preparation for drug-coated balloons, bio-resorbable vascular scaffolds, and drug-eluting stents. However, selection of a scoring device can result in difficulties associated with device delivery. It is considered that the use of leopard-crawl technique capitalizes on the design of the Lacrosse NSE catheter and can increase the success rate of device delivery in a clinical setting.
- Ashida K, Hayase T, Shinmura T. Efficacy of Lacrosse NSE Using the “Leopard-Crawl” Technique on Severely Calcified Lesions. J INVASIVE CARDIOL. 2013;25(10):555-564.
A selection of recent “New Technique” articles:
- Shammas NW. JetStream Atherectomy for Treating Iatrogenic Occlusion of a Stented Common Femoral Artery Following Deployment of Angio-Seal Closure Device. J INVASIVE CARDIOL 2013;25(9):475-477.
- Michael TT, Banerjee S, Brilakis ES. Subintimal Distal Anchor Technique for “Balloon-Uncrossable” Chronic Total Occlusions. 2013;25(10):552-554.
- Abi Rafeh N, Quevedo HC, DeAndrade KB, Yalvac EA, Dehghani H, Arain SA. The Double Angio-Seal Technique for Arterial Closure Following Large-Bore Access. J INVASIVE CARDIOL 2013;25(8):412-414.
- Marzullo R, Aprile A, Sangiorgi G. Capture and Repositioning of Third-Generation Migrated Abdominal Endovascular Graft by Bilateral Femoral Wire Externalization and Pulling by “Horse-Riding” Technique Followed by Balloon EVG Stabilization. J INVASIVE CARDIOL 2012;24(12):685-688.