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Suzuka Y, Hirano K, Tokuda T, Diaz JP. JETWING technique: Combination therapy of JETSTREAM Ⓡ and aggressive wire recanalization in calcified atheroma and dilatation technique for eccentric heavy calcified plaques using WINGMAN for insertion of protection wire. Catheter Cardiovasc Interv 2024; 103:335-339. [PMID: 38093582 DOI: 10.1002/ccd.30936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/31/2024]
Abstract
Although endovascular treatment (EVT) has developed and still progressing, calcified lesions remain a big challenge to operators in obtaining good results. Whenever, the eccentric and calcified plaques or nodules are present, balloon dilatation may be difficult and vascular complications may frequently occur. We present a 73-year-old woman, with severe, eccentric, calcified lesion in the right superficial femoral artery (SFA). First, we performed the aggressive wire recanalization in calcified atheroma and dilatation (ARCADIA) technique for the eccentric plaques. Then, we used a WingmanⓇ crossing catheter (ReFlow Medical, Inc.) to penetrate and pass through the calcifications and eventually exchanged to a ParachuteⓇ (Good Care, Inc.) filter wire. Finally, we performed rotational atherectomy using the JETSTREAMⓇ (Boston Scientific) rotational atherectomy device for debulking to obtain good lesion expansion and was able to avoid potential complications. Performing ARCADIA technique then using a Wingman catheter for inserting a filter wire before JETSTREAMⓇ atherectomy is safe and effective for heavily calcified, eccentric lesions. Further studies will be needed to validate the safety and efficacy of this approach.
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Affiliation(s)
- Yuki Suzuka
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - James Patrick Diaz
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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Mori S, Yamawaki M, Fukagawa T, Yamaguchi K, Mizusawa M, Shirai S, Honda Y, Tsutsumi M, Kobayashi N, Ito Y. Impact of "black rock" on clinical outcomes after endovascular therapy for de novo calcified femoropopliteal lesions. Heart Vessels 2023; 38:1356-1363. [PMID: 37369857 DOI: 10.1007/s00380-023-02284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
The relationship between severity of calcification and clinical outcomes after endovascular therapy (EVT) for femoropopliteal lesions is well known. We often encounter dense calcifications in our daily practice, which are darker than normal calcifications on angiography. Accordingly, we named it "black rock" (BR), and investigated its impact on clinical outcomes after EVT. We retrospectively analyzed 677 lesions in 495 patients who underwent EVT for de novo calcified femoropopliteal lesions at our hospital between April 2007 and June 2020. BR is defined as a calcification which is 1 cm or more in length, occupies more than half of the vessel diameter, and appears darker than the body of the femur on angiography. Propensity score matching analysis was performed to compare clinical outcomes between lesions with BR [BR (+) group] and without BR [BR (-) group]. A total of 119 matched pairs of lesions were analyzed. Primary patency at 2 years was significantly lower in the BR (+) group than in the BR (-) group (48% vs. 75%, p = .0007). Multivariate analysis revealed that the presence of BR [hazard ratio (HR) = 2.23, 95% confidence interval (CI); 1.48-3.38, p = .0001], lesion length (HR = 1.03, 95%CI; 1.00-1.06, p = .0244), and no scaffold use (HR = 1.58, 95%CI; 1.06-2.36, p = .0246) were predictors of restenosis. The presence of BR is independently associated with clinical outcomes after EVT for de novo calcified femoropopliteal lesions.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan.
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Tomoya Fukagawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Kohei Yamaguchi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Masafumi Mizusawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
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Ozaki D, Yokoyama K, Miyazaki T, Hirabayashi K, Abe H, Yabe K, Kakihara M, Maki M, Shimai R, Isogai H, Ouchi S, Yasuda Y, Odagiri F, Takamura K, Yaginuma K, Tokano T, Iwasaki T, Kawai S, Minamino T. Objective Evaluation With Noncontrast Computed Tomography Can Reveal Calcified Plaque Solidity in Peripheral Artery Diseases. J Endovasc Ther 2023:15266028231170119. [PMID: 37128871 DOI: 10.1177/15266028231170119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The presence of severely calcified plaque remains problematic in endovascular therapy, and no specific endovascular treatment strategy has been established. Estimating plaque solidity before the procedure may help operators penetrate calcified plaque with a guide wire. The aim of this study was to establish a method of measuring plaque solidity with noncontrast computed tomography (CT). METHODS This retrospective, single-center study included consecutive patients who, between October 2020 and July 2022, underwent noncontrast 5 mm and 1 mm CTs before endovascular therapy to penetrate calcified plaque with a wire in the common femoral, superficial femoral, and popliteal arteries. Three cross-sectional CT slices were selected. To target a calcified plaque lesion, the operator identified a region of interest, which corresponded to 24×24 pixels, and Hounsfield unit (HU) values of each pixel were displayed on the CT image. The average HU values and the ratio of number of pixels of lower values (130-599 HU) represented plaque solidity. We used the Mann-Whitney-Wilcoxon rank-sum test and the chi-square test to compare the solidity of plaques penetrated and not penetrated by the wire. RESULTS We evaluated 108 images of 36 calcified plaque lesions (in 19 patients). The wire penetrated 28 lesions (77.8%) successfully. The average HU value was significantly lower in the lesions that the wire penetrated than in the others, in both the 5 mm CT slices (434.7±86.8 HU vs 554.3±112.7 HU, p=0.0174) and 1 mm slices (497.8±103.1 HU vs 593.5±114.5 HU, p=0.0381). The receiver operating curve revealed that 529.9 and 533.9 HU in the 5 and 1 mm slices, respectively, were the highest values at which wires could penetrate. Moreover, at the lesions that were penetrates successfully, the ratio of number of lower HU value pixels was significantly higher both in 5 mm slice CTs (74.7±13.4 vs 61.7±13.1%, p=0.0347) and 1 mm (68.7±11.8 vs 57.1±11.4%, p=0.0174). CONCLUSION The use of noncontrast CT to evaluate plaque solidity was associated with successful wire penetration of calcified lesions in peripheral arteries. CLINICAL IMPACT This study revealed an association between the wire penetration inside calcified plaque and plaque solidity estimated using non-contrasted computed tomography. The mean Hounsfield unit values of three cross-sections in calcified plaques were associated with the successful wire penetration. This wire penetration difficulty is associated with extended procedure time, excessive radiation exposure, usage of extra contrast agents, and increased medical costs. Therefore, estimating calcified plaque solidity before procedure enables us to choose effective and lean procedures. In addition, to predict the success of dilating calcified plaque from the inside is also beneficial when the operator wants to avoid extra scaffold implantation for target lesions.
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Affiliation(s)
- Dai Ozaki
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Ken Yokoyama
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Koji Hirabayashi
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Hiroshi Abe
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Kosuke Yabe
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Midori Kakihara
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Masaaki Maki
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Ryosuke Shimai
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Hiroyuki Isogai
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Hospital, Tokyo, Japan
| | - Yuki Yasuda
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Fuminori Odagiri
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Kazuhisa Takamura
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Takashi Tokano
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Takashi Iwasaki
- Department of Radiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Satoru Kawai
- Department of Radiology, Juntendo University Urayasu Hospital, Urayasu-shi, Japan
| | - Toru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Hospital, Tokyo, Japan
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