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PLACQUE MODIFICATION DEVICES AND COMPLEX LESIONS ARTHUR LEE MD KAISER PERMANENTE Kaiser Southbay Interventional Cardiology PLACQUE MODIFICATION TREAT SPECIFIC RESISTANT LESIONS TO ALLOW PASSAGE OF DEVICES IMPROVE PROCEDURE SUCCESS AND LOWER PROCEDURE TIME IMPROVE LONG TERM OUTCOMES Kaiser Southbay Interventional Cardiology LESION PREPARATION • Patients with diabetes, renal failure and hypertension • Older patients who fail medical therapy Vessel Compliance • Plaque modification to improve vessel compliance Challenging Lesions Virmani R, Farb A, Burke AP Coronary angioplasty from the perspective of atherosclerotic plaque: Morphologic predictors of immediate success and restenosis Am Heart J 1994;127:163–79 • Enable full stent expansion, which is related to a reduction in ISR, TLR, and stent thrombosis Clinical Outcomes Flextome® Cutting Balloon® Device Conventional Angioplasty + Microsurgical Technology ATHEROTOMES • Affixed to a nylon non-compliant balloon • Expand radically as balloon is inflated to score arterial plaque Maverick® Catheter platform Atherotome: microsurgical blade with flex points Cutting Balloon® Device Mechanism of Action Atherotome 0.014” Wire Relative Size Porcine artery model • Atherotome creates microsurgical incision in the vessel wall • Weakened areas can then be dilated at lower pressures, changing lesion compliance Bonan, J Invasiv Cardiol, 1999; 11: 230 Photo taken by Boston Scientific Results of pre-clinical studies are not predictive of clinical performance Clinical results may vary AngioSculpt PTCA • Flexible, nitinol scoring element with three rectangular spiral struts works in tandem with a semi-compliant balloon to prep the target lesion for DES • Semi-compliant balloon allows tailoring of the device size to vessel size (2–20 atm) • Nitinol-enhanced balloon deflation for excellent rewrap and re-cross capabilities ©2015 Spectranetics All Rights Reserved Approved for External Distribution D025646-00 042015 Better Stent Expansion with Angiosculpt • • • • Final stent luminal dimensions are an important predictor of better long-term results4 Pre-dilatation yields a 33%–50% greater luminal gain than direct stenting or pre-dilatation with a conventional angioplasty balloon catheter (p>0.004)1 Pre-dilatation resulted in a post-stent luminal area ≥5.0 mm2 89% of the time, compared to only 74% with direct stenting or pre-dilatation with a conventional angioplasty balloon catheter (p