Peripheral Vascular Disease and Intervention
“CROSSVAC” - A New Flossing Strategy for Severe Calcified Lesion
Yukihiro Yamaguchi1, Hideyuki Takimura1, Reiko Tsukahara1, Masatsugu Nakano1, Satoru Nishio1, Yukako Takimura1, Mami Kawano1, Emi Tajima1, Ippei Tsuzuki1, Rintaro Taniguchi1
Tokyo General Hospital, Japan1
Severely calcified lesion is one of the most difficult cases for EVT (Endovascular Treatment). Calcified nodule known as protruding calcification is also particularly challenging in the field of EVT due to poor dilatation and healthy mesial damage resulting in a high restenosis rate. In addition, it is necessary to get adequate pre-dilation before using Drug Eluting Balloon (DCB) in joint sites such as the femoral or popliteal artery where Drug Eluting Stent (DES) is not an option. We have found that eccentric calcification is a major obstacle in patients who require a femoral artery access site for the treatment of structural heart disease (SHD) such as TAVI (Transcatheter Aortic Valve Implantation).
Therefore, we propose a new aggressive flossing method, Crosser® + E-VAC system "CROSSVAC" which enables us to reduce the volume of eccentric calcification and achieve sufficient lesion expansion. First, E-VAC (thrombus aspiration catheter) is inserted into the lesion, then Crosser® is inserted into it. The tip of the E-VAC is bent at an angle, the short end is rotated toward the calcification and move both back and forth simultaneously. In a lesion with large vessel, balloon dilation is performed on the opposite side of the lesion to allow the floss to be more closely aligned with the calcification. Furthermore, E-VAC also straightens curved small and medium vessels, allowing the Crosser® to be used more effectively.We will show the procedures and efficacy in our hospital.
We performed the CROSSVAC method for 24 patients with severe eccentric calcified lesions from September 2019 to January 2022. The Study design was a retrospective, non-randomized study. The primary composite outcome was technical, angiographic success rate and complications, major secondary outcomes was the minimum lumen area of the lesion as measured by IVUS (Intravascular Ultrasound) or OFDI (Optical Frequency Domain Imaging).
Results showed that technical and angiographic success rates were both 100%. In 15 cases, IVUS or OFDI were used and the MLA at the lesion was significantly larger in the CROSSVAC method compared to Crosser® alone (4.4±2.8mm vs 9.9±6.9mm; p=0.001). After balloon dilation, the MLA was even significantly enlarged (9.9±6.9mm vs 17.8±9.7mm; p<0.001).
In conclusion, “CROSSVAC” is a new and aggressive flossing method which is extremely useful to reduce eccentric calcification and get enough modification and lower risk of complication is expected.