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Using 6-mm Cutting Balloon Angioplasty in Patients with Resistant Peripheral Artery Stenosis: Preliminary Results

¹ Department of Radiology, St. George's Hospital, Blackshaw Rd., London SW17 0QT, United Kingdom.
² Present address: Department of Radiology, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany.

View larger version (59K): [in a new window]   Fig. 1A. —Peripheral Cutting Balloon (InterVentional Technologies, San Diego, CA). Photograph of balloon in deflated state shows microtomes (arrows) covered by balloon folds (arrowheads).

View larger version (67K): [in a new window]   Fig. 1B. —Peripheral Cutting Balloon (InterVentional Technologies, San Diego, CA). Photograph of balloon during inflation shows microtomes (black arrows) exposed and pressed into adjacent structures. Balloon expands vessel wall, resulting in directed longitudinal dissection at angioplasty site. This mechanism should minimize wall tension during angioplasty and enable angioplasty of rigid lesions to larger diameter than achieved using conventional angioplasty. Radiopaque markers (white arrows) can be seen through balloon material. Four-leg support (arrowheads) assists in retraction of blades into balloon folds during deflation.

View larger version (95K): [in a new window]   Fig. 2A. —42-year-old woman 8 years after hysterectomy for carcinoma of cervix and subsequent pelvic radiotherapy (58.3 Gy) with new onset of pain in right leg while at rest. Digital subtraction angiogram reveals focal stenosis (arrowhead) of right proximal external iliac artery consistent with irradiation-induced stenosis with intra arterial systolic pressure gradient of 40 mm Hg before intervention.

View larger version (90K): [in a new window]   Fig. 2B. —42-year-old woman 8 years after hysterectomy for carcinoma of cervix and subsequent pelvic radiotherapy (58.3 Gy) with new onset of pain in right leg while at rest. Unsubtracted image shows persisting balloon waist (arrowhead), indicating resistance to conventional angioplasty with 7 x 4 cm angioplasty balloon (Smash; Boston Scientific International, La Garenne Colombes, France) at inflation pressure of 14 atm.

View larger version (92K): [in a new window]   Fig. 2C. —42-year-old woman 8 years after hysterectomy for carcinoma of cervix and subsequent pelvic radiotherapy (58.3 Gy) with new onset of pain in right leg while at rest. Digital subtraction angiogram immediately after attempted conventional angioplasty reveals residual stenosis (arrowhead) that had 35 mm Hg systolic pressure gradient on intraarterial pressure assessment.

View larger version (115K): [in a new window]   Fig. 2D. —42-year-old woman 8 years after hysterectomy for carcinoma of cervix and subsequent pelvic radiotherapy (58.3 Gy) with new onset of pain in right leg while at rest. Unsubtracted image shows response to Cutting Balloon (InterVentional Technologies, San Diego, CA) angioplasty with full expansion of device (arrowhead) at 8 atm.

View larger version (83K): [in a new window]   Fig. 2E. —42-year-old woman 8 years after hysterectomy for carcinoma of cervix and subsequent pelvic radiotherapy (58.3 Gy) with new onset of pain in right leg while at rest. Digital substraction angiogram after Cutting Balloon angioplasty shows angioplasty site (arrowheads) has no residual stenosis. Intraarterial pressure assessment showed no systolic pressure gradient. In this patient, Cutting Balloon angioplasty was not followed by conventional angioplasty.

View larger version (99K): [in a new window]   Fig. 3A. —67-year-old man with claudication at 20 m, 3 years after stenting from common to external iliac artery (balloon expandable 8-mm stainless steel, Bridge X3: Medtronic, Santa Rosa, CA). Digital subtraction angiogram reveals in-stent restenosis (arrowhead) with 40 mm Hg intraarterial systolic pressure gradient.

View larger version (103K): [in a new window]   Fig. 3B. —67-year-old man with claudication at 20 m, 3 years after stenting from common to external iliac artery (balloon expandable 8-mm stainless steel, Bridge X3: Medtronic, Santa Rosa, CA). Digital subtraction angiogram shows significant residual stenosis (arrowheads). After attempted conventional angioplasty with 7 x 4 cm balloon (Smash; Boston Scientific International, La Garenne Colombes, France) using inflation pressure of 14 atm, systolic pressure gradient (40 mm Hg) was unchanged.

View larger version (87K): [in a new window]   Fig. 3C. —67-year-old man with claudication at 20 m, 3 years after stenting from common to external iliac artery (balloon expandable 8-mm stainless steel, Bridge X3: Medtronic, Santa Rosa, CA). Digital subtraction angiogram shows minimal residual stenosis (arrowhead) with residual systolic pressure gradient of 6 mm Hg after Cutting Balloon (InterVentional Technologies, San Diego, CA) angioplasty with inflation pressure of 8 atm.

View larger version (75K): [in a new window]   Fig. 3D. —67-year-old man with claudication at 20 m, 3 years after stenting from common to external iliac artery (balloon expandable 8-mm stainless steel, Bridge X3: Medtronic, Santa Rosa, CA). Digital subtraction angiogram shows unremarkable appearance of angioplasty site (arrowhead) after subsequent conventional angioplasty using same size (7 x 4 cm) conventional angioplasty balloon. Intraarterial pressure assessment confirmed unchanged systolic gradient of 6 mm Hg.

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