Cardiovascular Business - January/February 2009 - (Page 15)

While intravascular ultrasound (ivUS) is used extensively in coronary revascularization procedures to measure vessel size, there is no likewise reimbursement for ivUS use in the peripheries. We use the Metricath libra balloon, seen here in the distal peroneal artery, to precisely measure vessels to the hundredth millimeter. vessel is 2.18 mm. We have had excellent results, especially in deliverability, with the vascuTRaK2 PTa dilatation catheter, which uses two wires along the longitudinal axis to optimize focal pressure angioplasty. bris. Atherectomy is accomplished utilizing a unique proprietary device tip with small cutting blades. There has been limited U.S. experience with this device, but promising results have been reported from Europe. Specialty Balloons One of the significant advances in the last five years with PVI technology has occurred with the development of multiple specialty balloons designed for PVI. These include the PolarCath (Boston Scientific), AngioSculpt (AngioScore), VascuTRAK2 system (IDev), traditional Cutting Balloon (Boston Scientific), drugeluting balloons and the release of several long, low-profile PTA balloons specifically designed for CLI and treating infrapopliteal arteries (Invatec). Several reports describe adequate early and midterm results in treating CLI with PTA only. This group of specialty balloons has been developed and advocated to improve upon the PTA-only results. The PolarCath uses -10°C cryotherapy and theoretically apoptosis to decrease intimal hyperplasia and dissections. Multicenter data have not proven statistical significance versus PTA, but we continue to find cryotherapy useful in recurrent lesions, discrete lesions, in-stent restenosis and vessels in which avoiding a stent is important such as the common femoral and infrapopliteal arteries. The Cutting Balloon utilizes straight stainless steel blades and has data supporting its benefits in treating PAD and CLI. We have found this technology to be useful in larger vessels with discrete refractory lesions to other PTA technologies. Cost, profile and less deliverability are somewhat of a disadvantage, but we continue to find usefulness, especially in the larger vessels. The AngioSculpt is a lower-profile cutting-balloon technology utilizing multiple nitinol-based cutting blades placed on the balloon shaft in a circumferential fashion. Supportive data are also available and this technology is easily delivered in vessels as small as 2 mm. We have found it especially useful in localized non- or minimally-calcified discreet superficial femoral arteries, infrapopliteal arteries or graft anastomotic lesions. A limiting factor with this technology is its maximum length at 40 cm. The VascuTRAK2 is a recently commercially available PTA system that is highly deliverable and available in diameters from 2 mm to 6 mm and lengths from 20 mm up to 200 mm. A 300 mm system will soon be available. This balloon is delivered by two wires along the longitudinal axis, which allows for maximal “focal pressure” PTA, or FPP. Slower balloon inflation is advocated to allow for optimal FPP, which, in concept, may decrease intimal hyperplasia and decrease the incidence and severity of intimal hyperplasia. Our initial results have been excellent, especially in delivering this long catheter-based technology into the infrapopliteal vessels down to the ankle that will allow a single inflation to cover the entire infrapopliteal and, occasionally, popliteal artery systems. We will soon embark upon treatments in the U.S. with drugeluting balloons. The European-based THUNDER Trial was published comparing a paclitaxel-coated balloon with PTA. Encouraging results were reported and a similar balloon should be available in the U.S. within the next 12 months. An interesting balloon-based technology combined with radiofrequency (RF) and thermal energy is being developed by Minnow Medical, but is not commercially available. This balloon-based technology will deliver a series of RF microfilaments arranged on the balloon that can be individually calibrated and controlled. This potentially would afford highly selective delivery of RF thermal energy within the target vessel in hopes to deliver positive tract modification and improve non-stent results. In summary, there are multiple emerging PVI strategies and technologies available today that are increasingly being performed in the contemporary cath lab with the potential to significantly improve PVI outcomes, even in the most complex cases. CardiovascularBusiness.com Cardiovascular Business 15 http://www.CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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