Author + information
- Received May 18, 2015
- Accepted June 5, 2015
- Published online October 1, 2015.
- Yohei Sotomi, MD∗,
- Nicolas W. Shammas, MD†,
- Pannipa Suwannasom, MD∗,‡,
- Carlos M. Campos, MD§,‖,¶,
- Joanna J. Wykrzykowska, MD, PhD∗,
- Robbert J. de Winter, MD, PhD∗,
- Jouke Dijkstra, PhD¶,
- Patrick W. Serruys, MD, PhD# and
- Yoshinobu Onuma, MD, PhD‡∗ ()
- ∗Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- †Midwest Cardiovascular Research Foundation, Davenport, Iowa
- ‡ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
- §Department of Interventional Cardiology, Heart Institute (InCor) University of São Paulo Medical School (USP), São Paulo, SP, Brazil
- ‖Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- ¶Leiden University Medical Center, Leiden, the Netherlands
- #International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Yoshinobu Onuma, Thorax Center, Erasmus Medical Center, Dr. Molewaterplein 40,′s-Gravendijkwal 230 Rotterdam, Zuid-Holland 3015CE, the Netherlands.
A 75-year-old man with arteriosclerosis obliterans was admitted to undergo a staged percutaneous peripheral intervention for a subtotal occlusion of a left peroneal artery (pre-procedure, Figure 1A,a). After guidewire crossing, orbital atherectomy was performed with the STEALTH 360° Peripheral Orbital Atherectomy System (OAS), 1.25-mm Solid Micro Crown (Cardiovascular Systems, Inc., St. Paul, Minnesota) (Figure 1F; post-OAS, Figure 1B,b). The first run was performed at 80,000 rpm for 30 s followed by the second run at 140,000 rpm for 25 s. The final balloon angioplasty was performed using Armada 14 (Abbott Vascular, Santa Clara, California), 2.0/120 mm, 10 atm maximum pressure) (post-procedure, Figure 1C,c). Intravascular ultrasound (IVUS) (EagleEye, Volcano Corporation, Cordova, California) was performed before and after OAS. The cross section of interest is indicated in Figure 1D (pre-OAS) and Figure 1D′ (post-OAS). Offline echogenicity analysis of IVUS (1–3) by QCU-CMS software (Medis, Leiden, the Netherlands) revealed fragmentation of the calcified plaque demonstrated by the appearance of multiple “radii” of hypo- or low echogenicity and by reduction of the calcified area as detected by the software (10.97% to 4.64%) (pre-OAS, Figure 1E; post-OAS, Figure E′; Table).
Debulking with OAS was reported to increase the chance of reaching a desirable balloon angioplasty result with a higher procedure success rate and with less acute need for bailout stenting (4). This case report evaluates quantitatively by echogenicity the debulking effect of OAS on a peripheral calcified stenosis.
Dr. Shammas has received research and educational grants from Cardiovascular Systems Inc. and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 18, 2015.
- Accepted June 5, 2015.
- American College of Cardiology Foundation
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