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An update on vessel preparation in lower limb arterial intervention

BACKGROUND: Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim...

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Detalles Bibliográficos
Autores principales: Ormiston, William, Dyer-Hartnett, Shelagh, Fernando, Rukshan, Holden, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695779/
https://www.ncbi.nlm.nih.gov/pubmed/33245456
http://dx.doi.org/10.1186/s42155-020-00175-6
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author Ormiston, William
Dyer-Hartnett, Shelagh
Fernando, Rukshan
Holden, Andrew
author_facet Ormiston, William
Dyer-Hartnett, Shelagh
Fernando, Rukshan
Holden, Andrew
author_sort Ormiston, William
collection PubMed
description BACKGROUND: Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim to give an overview of some of the devices currently available, or under investigation, for vessel preparation in the lower limb. MAIN TEXT: Vessel preparation devices include those that remove plaque (atherectomy devices) and those that modify plaque. The four groups of plaque removing atherectomy devices are defined by their plaque removal method: Directional, rotational orbital and excimer laser are categories of devices investigated for plaque modification. Intravascular lithotripsy devices generate sonic pulsatile pressure waves that pass into the vessel wall cracking calcified plaques whilst sparing soft tissue. This enables dilatation of calcified lesions at low pressure by conventional balloons and enables full stent expansion. Other balloon based vessel preparation devices were designed to modify plaque and produce more controlled, lower pressure luminal expansion without major dissections and potentially with less recoil than conventional angioplasty balloons. Scoring balloons have a helical nitinol element attached to the balloon that scores plaque facilitating uniform luminal enlargement. Further specialty balloons have been developed in recent years, including the Chocolate, Phoenix and Serranator balloons. Finally, the temporary Spur self-expanding retrievable nitinol stent has a series of radially aligned spurs that are driven into the vessel wall by post-dilatation, potentially improving drug delivery. CONCLUSION: Lesion specific vessel preparation aims to improve both short and long term outcomes through improved penetration of anti-proliferative drug, maximising luminal gain, reducing the need for stent placement and minimising intimal injury. Some forms of vessel preparation appear to improve short term outcomes; long-term outcomes remain uncertain. An overview of some of the multiple devices available for vessel preparation is presented.
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spelling pubmed-76957792020-11-30 An update on vessel preparation in lower limb arterial intervention Ormiston, William Dyer-Hartnett, Shelagh Fernando, Rukshan Holden, Andrew CVIR Endovasc New Technologies BACKGROUND: Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim to give an overview of some of the devices currently available, or under investigation, for vessel preparation in the lower limb. MAIN TEXT: Vessel preparation devices include those that remove plaque (atherectomy devices) and those that modify plaque. The four groups of plaque removing atherectomy devices are defined by their plaque removal method: Directional, rotational orbital and excimer laser are categories of devices investigated for plaque modification. Intravascular lithotripsy devices generate sonic pulsatile pressure waves that pass into the vessel wall cracking calcified plaques whilst sparing soft tissue. This enables dilatation of calcified lesions at low pressure by conventional balloons and enables full stent expansion. Other balloon based vessel preparation devices were designed to modify plaque and produce more controlled, lower pressure luminal expansion without major dissections and potentially with less recoil than conventional angioplasty balloons. Scoring balloons have a helical nitinol element attached to the balloon that scores plaque facilitating uniform luminal enlargement. Further specialty balloons have been developed in recent years, including the Chocolate, Phoenix and Serranator balloons. Finally, the temporary Spur self-expanding retrievable nitinol stent has a series of radially aligned spurs that are driven into the vessel wall by post-dilatation, potentially improving drug delivery. CONCLUSION: Lesion specific vessel preparation aims to improve both short and long term outcomes through improved penetration of anti-proliferative drug, maximising luminal gain, reducing the need for stent placement and minimising intimal injury. Some forms of vessel preparation appear to improve short term outcomes; long-term outcomes remain uncertain. An overview of some of the multiple devices available for vessel preparation is presented. Springer International Publishing 2020-11-27 /pmc/articles/PMC7695779/ /pubmed/33245456 http://dx.doi.org/10.1186/s42155-020-00175-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle New Technologies
Ormiston, William
Dyer-Hartnett, Shelagh
Fernando, Rukshan
Holden, Andrew
An update on vessel preparation in lower limb arterial intervention
title An update on vessel preparation in lower limb arterial intervention
title_full An update on vessel preparation in lower limb arterial intervention
title_fullStr An update on vessel preparation in lower limb arterial intervention
title_full_unstemmed An update on vessel preparation in lower limb arterial intervention
title_short An update on vessel preparation in lower limb arterial intervention
title_sort update on vessel preparation in lower limb arterial intervention
topic New Technologies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695779/
https://www.ncbi.nlm.nih.gov/pubmed/33245456
http://dx.doi.org/10.1186/s42155-020-00175-6
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