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The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure

BACKGROUND: The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the “no stenting zone”, is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strateg...

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Autores principales: Haraguchi, Takuya, Fujita, Tsutomu, Kashima, Yoshifumi, Tsujimoto, Masanaga, Takeuchi, Tsuyoshi, Tadano, Yutaka, Hachinohe, Daisuke, Kaneko, Umihiko, Kobayashi, Ken, Kanno, Daitaro, Sato, Katsuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476692/
https://www.ncbi.nlm.nih.gov/pubmed/34570312
http://dx.doi.org/10.1186/s42155-021-00258-y
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author Haraguchi, Takuya
Fujita, Tsutomu
Kashima, Yoshifumi
Tsujimoto, Masanaga
Takeuchi, Tsuyoshi
Tadano, Yutaka
Hachinohe, Daisuke
Kaneko, Umihiko
Kobayashi, Ken
Kanno, Daitaro
Sato, Katsuhiko
author_facet Haraguchi, Takuya
Fujita, Tsutomu
Kashima, Yoshifumi
Tsujimoto, Masanaga
Takeuchi, Tsuyoshi
Tadano, Yutaka
Hachinohe, Daisuke
Kaneko, Umihiko
Kobayashi, Ken
Kanno, Daitaro
Sato, Katsuhiko
author_sort Haraguchi, Takuya
collection PubMed
description BACKGROUND: The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the “no stenting zone”, is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. MAIN TEXT: We propose a novel calcified plaque modification technique, named the “fracking technique” (FT). The term fracking refers to how a rock is fractured by the high hydraulic pressure. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in the right CFA. Conventional balloon angioplasty for the lesion yielded a suboptimal minimal lumen area (MLA), which increased from 6.2 to 10.7-mm(2) on intravascular ultrasound (IVUS). The FT was implemented to obtain a larger MLA. After the FT was repeated at three locations at up to 8-atm, a greater MLA of 27.1-mm(2) was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis due to diabetes mellitus who presented with ischemic pain in his right limbs at rest due to severe stenosis with eccentric calcification in the distal CFA. The MLA on IVUS before and after balloon angioplasty was 10.0-mm(2) and 13.1-mm(2), respectively, and this result was still suboptimal. The FT was attempted and successfully yielded a greater MLA of 28.9-mm(2) without complications. Restenosis has not been detected for 2 years follow-up period. CONCLUSIONS: The FT is an effective option for treating calcified CFA lesions to achieve a larger lumen area. Long-term follow-up studies are necessary. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42155-021-00258-y.
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spelling pubmed-84766922021-10-08 The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure Haraguchi, Takuya Fujita, Tsutomu Kashima, Yoshifumi Tsujimoto, Masanaga Takeuchi, Tsuyoshi Tadano, Yutaka Hachinohe, Daisuke Kaneko, Umihiko Kobayashi, Ken Kanno, Daitaro Sato, Katsuhiko CVIR Endovasc New Technologies BACKGROUND: The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the “no stenting zone”, is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. MAIN TEXT: We propose a novel calcified plaque modification technique, named the “fracking technique” (FT). The term fracking refers to how a rock is fractured by the high hydraulic pressure. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in the right CFA. Conventional balloon angioplasty for the lesion yielded a suboptimal minimal lumen area (MLA), which increased from 6.2 to 10.7-mm(2) on intravascular ultrasound (IVUS). The FT was implemented to obtain a larger MLA. After the FT was repeated at three locations at up to 8-atm, a greater MLA of 27.1-mm(2) was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis due to diabetes mellitus who presented with ischemic pain in his right limbs at rest due to severe stenosis with eccentric calcification in the distal CFA. The MLA on IVUS before and after balloon angioplasty was 10.0-mm(2) and 13.1-mm(2), respectively, and this result was still suboptimal. The FT was attempted and successfully yielded a greater MLA of 28.9-mm(2) without complications. Restenosis has not been detected for 2 years follow-up period. CONCLUSIONS: The FT is an effective option for treating calcified CFA lesions to achieve a larger lumen area. Long-term follow-up studies are necessary. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42155-021-00258-y. Springer International Publishing 2021-09-27 /pmc/articles/PMC8476692/ /pubmed/34570312 http://dx.doi.org/10.1186/s42155-021-00258-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/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/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle New Technologies
Haraguchi, Takuya
Fujita, Tsutomu
Kashima, Yoshifumi
Tsujimoto, Masanaga
Takeuchi, Tsuyoshi
Tadano, Yutaka
Hachinohe, Daisuke
Kaneko, Umihiko
Kobayashi, Ken
Kanno, Daitaro
Sato, Katsuhiko
The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
title The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
title_full The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
title_fullStr The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
title_full_unstemmed The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
title_short The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
title_sort “fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure
topic New Technologies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476692/
https://www.ncbi.nlm.nih.gov/pubmed/34570312
http://dx.doi.org/10.1186/s42155-021-00258-y
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