ABSTRACT
Figure 6.1 The cutting balloon blades are approximately five times sharper than a new surgical scalpel blade.
Atherotome™ Surgical Scalpel
The microsurgical dilatation concept combines conventional balloon angioplasty with advanced microsurgical capability. The concept is to ‘cut’ first and then dilate, resulting in a reduction in histological damage outside the cutting area compared to the standard balloon (Figs 6.4 and 6.5). The resultant lumen enlargement occurs due to widening of these initial cuts through the balloon inflation, relieving the ‘hoop stress’ of the vessel, thereby reducing the elastic and fibrotic continuity. Due to that peculiar mechanism of action, it should be emphasized that inflation pressure should be kept = 8 atm and the balloon/artery ratio should be targeted between 1.0 and 1.1 to avoid deep vascular wall incisions (Fig. 6.6). The indications for the use of the cutting balloon are listed in Table 6.1. The two main contraindications are tortuous/angled vessels resulting in difficult access due to balloon stiffness (although the shorter 10 mm balloon can be used in this situation) and a risk of rupture, and severely calcified lesions which may also result in wall perforation (but can be treated with the cutting
Cutting balloon preparation and use Guiding catheter and guidewire selection is the same as with conventional PTCA. Good guiding catheter support is always recommended and the large lumen 7 Fr or 8 Fr guiding catheters are the catheters of choice. If the lesion is in the distal anatomy, in a tortuous vessel or severely stenosed, a support wire is recommended as with conventional PTCA.
