Title

A modified directional atherectomy catheter for resection of calcified atherosclerotic plaques

Document Type

Journal Article

Publication Date

1-1-1995

Journal

Coronary Artery Disease

Volume

6

Issue

4

DOI

10.1097/00019501-199504000-00011

Keywords

atherectomy; atherosclerosis; calcium; coronary artery disease

Abstract

Background: The purpose of this study was to determine the feasibility of resecting calcified atherosclerotic plaques in human cadaveric vessels by using a modified directional coronary atherectomy catheter and to correlate these results with bench tests using an in-vitro sea coral model. Methods: The conventional directional coronary atherectomy catheter was modified by changing the cutter blade to a tungsten carbide material and by increasing the torsional strength of the drive cable. The performance of the modified directional coronary atherectomy (DCA) catheter was compared with the conventional catheter using a sea coral model to simulate calcified material. Then, 10 human ex-vivo arteries (eight with calcification) were treated with both conventional and modified catheters, and the results studied with intravascular ultrasound and confirmed by histologic examination. Results: Using the modified directional coronary atherectomy catheter it was possible to perform effective and consistent longitudinal cutting, and to resect a significantly larger amount of coral (1.0±0.1 mm2 versus 0.2±0.1 mm2 with conventional cutter, P<0.0001). In heavily calcified ex-vivo arteries, the modified catheter was more effective in removing calcified plaques (13±11 mg versus 3.7±1.4 mg with conventional cutter, P=0.07). Intravascular ultrasound confirmed the effective atherectomy (residual area stenosis 28±16% versus 47±10% with the conventional device, P<0.05), and histologic examination showed calcified nodules in the atherectomy samples obtained with the modified cutter (area of calcium 1.43±0.89 mm2 versus 0.93±0.83 mm2 with the conventional cutter). Conclusions: The modified directional coronary atherectomy catheter effectively removed both non-calcified and calcified plaques in the ex-vivo human cadaveric arteries, thus demonstrating the feasibility of directional coronary atherectomy of calcified plaques. This modified device shows promise for treating calcified coronary lesions, especially in larger vessels.

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