Cath Lab Digest - April 2008 - (Page 10)

10 NEW TECHNOLOGY APRIL 2008 Figure 3a. The solid crown. Figure 4b. Treatment with 1.75 mm Diamondback solid crown. Figure 4d. Adjunctive balloon angioplasty followed by orbital atherectomy. Figure 4a. Calcified distal superficial femoral artery occlusion. Figure 3b. The classic crown. orbiting and sanding are not occurring. In other words, even after resistance is no longer felt, the device will continue to sand until a maximal lumen is achieved for the selected crown size and arterial lumen in which it is orbiting. I usually start with a small crown and use it up to its maximum speed to achieve the largest lumen possible before upsizing to the next crown size, if necessary. Especially in below-the-knee lesions, orbital atherectomy will frequently produce a very acceptable standalone “stentlike” result. Hypothetically, preventing additional barotrauma may add value to long-term durability of the procedure by preventing restenosis. Verification of patency will likely evolve as we continue to see growth in the atherectomy device market and treatments addressed at preventing or reducing restenosis in the peripheral vasculature. How do the solid and classic crowns differ? The solid crown addresses the issue of additional luminal gain in larger vessel (Figure 3a). The 2.25 solid crown can achieve up to a 4.5 mm lumen, whereas a similarly sized classic crown will achieve a 3.8 mm lumen (Figure 3b). Certainly, having the diamond coating cover the entire crown increases the sanding surface area for debulking. In addition, having the diamond coating at the tip of the device improves its penetrating capacity through a difficult chronic total occlusion. The classic crown has a 1.25 mm crown, which is useful in treating smaller, more distal arteries. There are future crown design improvements underway to improve penetrating capacity and to address various types of plaque morphologies. What is the risk of dissection and perforation? Figure 4c. Treatment with 2.25mm Diamondback solid crown. More than 350 cases with the Diamondback were documented after the product was released in September of 2007 through the end of the year (CSI data on file). Results show low rates of dissection (2%), perforation (2.3%) and embolism (2%). These results support the use of orbital atherectomy as a safe revascularization technique. I do find that I use adjunctive therapy in fewer cases. When I do use adjunct therapy, I have found it is more successful when it is preceded by orbital atherectomy. Fibrocalcific plaque jeopardizes stent expansion in many lesions, and it is my opinion that an atherectomy procedure improves long-term results regardless of whether Figure 4e. Final “stent-like” result. you plan on stent placement. Plaque reduction and the smooth lumen created with orbital atherectomy will improve the ability of the stent to expand and therefore maximize luminal gain. In calcified lesions, where

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Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

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