Three-dimensional visualization of scoring mechanism of 'AngioSculpt' balloon for calcified coronary lesions using optical coherence tomography

Abstract

Despite developments in coronary interventional cardiology, plaque calcification is a critical issue of stent expansion. AngioSculpt Scoring Balloon Catheter^® (AngioSculpt; AngioScore Inc., Fremont, CA, USA) can produce more 'scoring' marks, which leads to prevention of 'plaque shift' and 'balloon slippage'; moreover, the 'scoring' produces some cutting effect, leading to successful stent implantation even on severe calcified lesions. We have applied AngioSculpt on severe calcified lesions to achieve its adequate expansion, and report the mechanism of the 'scoring' and its efficacy evaluated by three-dimensional stereoscopic reconstruction (3-D) of optical coherence tomography (OCT; LightLab Imaging, Inc., Westford, MA, USA). The patient is a 64-year-old male, who had diffuse stenosis in the left circumflex coronary artery (LCX) with severe calcifications, and was treated using AngioSculpt. AngioSculpt predilatation with a high pressure led to successful stent implantation. The radial scores were clearly imaged by 3-D OCT, demonstrating that radial nitinol wires made spiral indents from the relative weak points at the surface adjacent to calcification, which resulted in a less traumatic and safe dilatation although the scoring mark was not recognized clearly in intravascular ultrasound. This report suggests AngioSculpt might become one of the options for a severe calcified lesion.

Keywords: 3-D OCT; AngioSculpt; Calcified lesion; Optical coherence tomography (OCT); Scoring.

Figure 1

The structure of AngioSculpt. The AngioSculpt consists of a semicompliant balloon surrounded by spiral nitinol element, the purposes of which are to dilate and make a ‘scoring’ effect to complex lesions.

Figure 2

Coronary angiograms are shown before and after the procedure of the AngioSculpt 2.5/10 mm for predilatation of left circumflex artery lesions (arrows), and after the stent implantation (TAXUS-Liberte^® 3.0/28 mm, TAXUS-Liberte^® 3.5/28 mm; Boston Scientific Corporation, Minneapolis, MN, USA).

Figure 3

Two- and three-dimensional optical coherence tomography (OCT) images before and after AngioSculpt scoring. The OCT images before and after the procedure with AngioSculpt are presented, which correspond to the numbered section of angiogram of left circumflex artery. The panels of the same level of two-dimensional OCT images are in the same position (left: before scoring; right: after scoring). Three-dimensional representations of the OCT images around the lesions scored by this device are shown in the right panels. Severe calcifications are shown (*). Apparent ‘scoring’ marks can be observed (arrow ↑) having a safe dissection at non-calcified segment and an efficient dilatation of the calcified plaque.