Parag Patel, MD – Physician, Medical College of Wisconsin; Matthew scheidt, MD – Physician, Medical College of Wisconsin
Purpose: 1. Understand when plaque modification strategies need to be used. 2. Understand angioplasty related plaque modification strategies. 3. Understand atherectomy related plaque modification strategies. 4. Understand current data, complications, and limitations of these strategies.
Material and Methods: Chronically calcified atherosclerotic lesions cause challenges in the endovascular treatment of peripheral arterial disease. These challenges include impaired device delivery, decreased luminal revascularization, impaired stent expansion, increased risk of in-stent stenosis and thrombosis, and increased procedural time and cost in addition to increased overall radiation dose. Plaque modification or vessel prep is a strategy that can mitigate issues caused by chronically calcified lesions. There are a variety of balloons and atherectomy devices that can be used for vessel prep as detailed in this review. Operators should have an understanding of when to use these devices and what their limitations are.
Conclusions: There are a variety of balloon and atherectomy devices that can be used for vessel prep. Proper use of these devices can provide a means for improved outcomes for endovascular management of chronically calcified lesions.