Plain, Drug-Coated, and Cutting

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© Springer Science+Business Media, LLC, part of Springer Nature 2021
J. J. Hoballah, C. F. Bechara (eds.)Vascular Reconstructionshttps://doi.org/10.1007/978-1-0716-1089-3_22


22. Balloons: Plain, Drug-Coated, and Cutting



Chiranjiv Virk1, Claudie Sheahan1, Kevin Au1 and Malachi Sheahan1  


(1)
Division of Vascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA

 



 

Malachi Sheahan

Email: msheah@lsuhsc.edu


Keywords
Balloon angioplastyCutting balloonPaclitaxelRapid exchangeMonorail


Balloon Angioplasty


Arterial angioplasty was first reported by Dotter and Judkins in 1964 for the treatment of peripheral vascular lesions using rigid intravascular dilators [1]. Inflation of an angioplasty balloon in the artery causes dissection of the atherosclerotic plaque and adjacent intima. The medial and adventitial layers are also dilated. This controlled stretch injury increases the cross-sectional area of the vascular lumen. Over several weeks, the artery remodels via re-endothelialization of the intima [2, 3].


Types of Balloon Catheter


The two main types of balloon delivery catheters are over the wire (OTW) catheters and single operator exchange (SOE) catheters.


In OTW catheters (Fig. 22.1), the guidewire enters at the distal end of the balloon and exits at the proximal end of the catheter. Generally, OTW catheters offer more support than SOE catheters. Care must be taken to use a wire with adequate length when exchanging an OTW balloon angioplasty catheter. The minimum length of wire needed is the sum of the distance between the access site and the treatment lesion plus the length of the catheter plus 10 cm (Fig. 22.2).

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Fig. 22.1

Over-the-wire (OTW) balloon catheter


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Fig. 22.2

Calculating the minimum length of wire needed for use with an OTW balloon catheter


SOE catheters (Fig. 22.3) are also commonly referred to as rapid exchange or monorail systems. The wire enters at the distal end of the balloon and exits the catheter along the shaft approximately 10 inches proximal to the balloon. These delivery catheters offer the advantage of simpler catheter exchange, and they often eliminate the need for cumbersome exchange-length wires.

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Fig. 22.3

Single operator exchange (SOE) catheter. The wire exits the catheter along the shaft, proximal to the balloon


Both types of angioplasty balloon delivery catheters come in a variety of shaft lengths and outer diameter profiles. The shaft length is critical to determine whether the catheter is of adequate length to reach the target lesion. The shaft length also must be longer than the sheath or guiding catheter through which the balloon delivery catheter is being advanced. As an example, if a 90-cm destination sheath is placed, then a 75-cm working length balloon will not reach the lesion. The outer diameter profile will determine the minimum inner diameter of the sheath or guiding catheter through which the balloon can be advanced. In general, smaller-profile balloons are more likely to succeed in crossing extremely stenotic or occluded lesions. It is also important to note the recommended wire diameter. Balloon catheters often can be advanced over wires smaller than the recommended size, but not over wires that are larger. This can be helpful when using low-profile balloons over 0.014 wire for tibial lesions in which the same wire can be used for treating femoropopliteal lesions that usually go over an 0.035 wire. Note that there will be bleeding from the manifold because the wire is smaller in diameter.


Balloon delivery catheter specifications are listed on the packaging and should be noted prior to passing the device to the sterile field, to avoid waste. It is always a good idea to ensure sheath and wire compatibility before opening a balloon.


Angioplasty Technique: General Principles


Crossing the lesion: After obtaining vascular access, arteriography is performed to identify the lesion. The target vessel stenosis is crossed with a wire and support catheter. Once the lesion is crossed, the wire is withdrawn and contrast is injected into the crossing catheter to confirm its location in the true lumen. The wire is then re-advanced and the support catheter is exchanged for the balloon delivery catheter.


Balloon selection : The length of the balloon should be slightly longer than the length of the lesion being treated. Standard balloon lengths can vary from under 1 cm to 25 cm. The diameter of the balloon should generally match the width of a healthy section of the vessel being treated. Some general sizing guidelines are shown in Table 22.1.
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Jul 25, 2021 | Posted by in CARDIOLOGY | Comments Off on Plain, Drug-Coated, and Cutting

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