Successful Nitinol-Constrained Balloon Angioplasty With Controlled Minimal Dissection Observed by High-Resolution Intravascular Ultrasound and Angioscopy

Successful balloon angioplasty is key to successful endovascular intervention (EVT) for femoropopliteal lesions, especially for drug-coated balloon (DCB) treatment. We have reported that the dissection angle evaluated using intravascular ultrasound (IVUS) is a predictor of restenosis after DCB treatment.¹ A chocolate balloon (TriReme Medical Inc., Pleasanton, CA, USA) is a unique concept balloon characterized by a mounted nitinol-constraining structure that prevents the balloon from catching on lesions and causing torsion stress, resulting in a controlled and differential dilatation (Figure F).

Figure.

(A) Pre- and (B) postangiography, (C) pre- and (D) postintravascular ultrasound, and (E) postangioscopy images. (F) Ex vivo image of the inflated chocolate balloon.

A 77-year-old man presented with Rutherford Class 3 intermittent claudication. Occlusion of the distal superficial femoral artery was detected (Figure A), and EVT was performed. After passing the lesion with a 0.014-inch wire, high-resolution IVUS (60 mHz) was performed using an AltaView (Terumo Corporation, Tokyo, Japan). According to the IVUS image, the main component of the lesion was a soft plaque (Figure C; Supplementary Movie 1, Left panel). Slow and long inflation up to 6 atm with a nitinol-constrained chocolate balloon (5×80 mm) was performed. Angiography after ballooning showed good luminal gain without dissection (Figure B). The IVUS image showed good expansion with minor dissection (Figure D; Supplementary Movie 1, Left panel). IVUS images were obtained from a 9-mm/s automatic pullback. Using a side branch as a landmark, we performed an exact slice-by-slice comparison of pre- and post-IVUS images. An electronic high-resolution angioscope equipped with a 480,000-pixel imaging camera (Zemporshe^®; Ovalis, Osaka, Japan) was used, revealing good enlargement of the white smooth vessel wall (Figure E). DCB treatment was performed, and the intervention was completed. Therefore, nitinol-constrained chocolate balloon angioplasty may reduce dissection and contribute to successful balloon angioplasty.

Disclosures / IRB Information

None.

Supplementary Files

Supplementary Movie 1. Pre and post intravascular ultrasound images.

Supplementary Movie 2. Post angioscopy image.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-20-1313

Reference

• 1.   Kozuki A, Takahara M, Shimizu M, Kijima Y, Nagoshi R, Fujiwara R, et al. Outcomes of dissection angles as predictor of restenosis after drug-coated balloon treatment. J Atheroscler Thromb, doi:10.5551/jat.59774.