Novel balloon technologies to minimize dissection of peripheral angioplasty

ABSTRACT

Introduction: Percutaneous transluminal angioplasty (PTA) currently remains the endovascular treatment of choice in a large percentage of patients suffering from peripheral artery disease (PAD). However, the mechanism of angioplasty itself can cause some extent of arterial dissection leading to early vessel restenosis/reocclusion. Current endovascular imaging studies have reported a higher rate of arterial dissection than previously reported in literature and advocated the correlation of dissection with poor patency. Thus, there is the need of developing devices to minimize dissection and bailout stenting.

Areas covered: The present review focuses on newly-developed balloon angioplasty technologies designed to minimize arterial wall distress and consequently the rate of dissections. Available literature regarding three new specialty balloons is being reviewed, highlighting their value and limitations. Authors’ future perspective about the benefits of utilizing specialty balloons towards a metal free and dissection free future is also provided.

Expert opinion: By understanding the mechanism of angioplasty and thus developing devices which cause minimal or no arterial wall distress, the rate of dissections and bailout stenting can be minimized and long-term clinical outcomes of endovascular therapy can be optimized.

KEYWORDS:

• Balloon angioplasty
• chocolate balloon
• dissection
• endovascular treatment
• lithotripsy
• peripheral arterial disease

Article highlights

• Post-angioplasty severe, flow-limiting, dissections are correlated with poor patency results regardless of the use of bailout stenting.

• Recent intravascular imaging studies have demonstrated that the rate and degree of dissection following balloon angioplasty is higher than previously believed.

• Cutting and scoring balloon technologies have been developed to disrupt the atheromatous plaque and provide a successful the immediate result using low-pressure angioplasty to minimize dissection.

• Next-generation balloon angioplasty catheters, such as the chocolate balloon catheter and the intravascular lithotripsy system, utilize innovative technologies to minimize vessel injury and dissection especially when treating calcified lesions that tend to recoil after low-pressure and dissect after high-pressure balloon angioplasty.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer has patents in process for balloon inflation devices to reduce balloon complications. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.