Treatment of Lesions in Iliac and Femoral Arteries Using Low-Pressure Angioplasty With a Novel Scoring Device

Purpose: Treating calcified stenotic lesions in the iliac and common femoral arteries (CFAs) can be difficult and often requires high pressures of greater than 20 atmospheres (ATM) to dilate them adequately. Vessels with tough fibrous or calcified lesions and plaque can be difficult to treat and are prone to high rates of recoil, dissection, and restenosis, often requiring reintervention. The ability to effectively prep these vessels using low pressure helps minimize the risk of these complications.

Materials and Methods: XO Score (Transit Scientific) is a new type of scoring and cutting technology that enables low-pressure lesion dilatation and vessel prep with a broad range of standard off-the-shelf percutaneous transluminal angioplasty (PTA) balloons. The unique 1-piece metal-alloy exoskeleton construction adapts to the size, shape, and length of the physician-selected PTA balloon used inside it and converts it into a scoring and cutting vessel prep device.

Results: The patient presented with high-grade stenosis (80% stenosed) at the start of the right iliac, into the distal iliac and CFAs. Access to the treatment site was gained via retrograde femoral access on the right side using a 7F introducer. A 6-mm x 40-mm balloon was loaded inside of the XO Score and was advanced to the proximal section of the lesion site in the distal iliac. The PTA balloon was inflated to 3ATM, deflated, and then advanced to the second treatment site at the start of the right CFA. The PTA balloon was inflated to 4ATM at the eccentric lesion. The calcified lesions responded well at low 3 to 4ATM pressures using the XO Score device. No waisting or cinching of the balloon were present during either inflation, and no dissection was present post vessel prep. Post vessel prep, 2 stents were placed, 1 in each iliac. The procedure resulted in the successful recanalization of the right iliac and CFA.

Conclusions: This case demonstrates the successful use of low-pressure dilatation to treat challenging lesions in the iliac and CFAs, indicating a promising new approach to effectively revascularize CLI and limb-salvage patients.