Case presentation
Endovascular treatment was performed for an 89-year-old male with a symptomatic chronic total occlusion in the right superficial femoral artery (Figure 1A). After crossing the chronic total occlusion with a 0.014-inch wire, a red clot was collected by catheter thrombectomy. A 5.0 x 40-mm-long non-slip element percutaneous transluminal balloon angioplasty (NSE PTA) —a scoring balloon— (Nipro Corporation, Osaka, Japan) was inflated three times without shaft rotation (NSE three inflations) (Figure 1B). After that, angiography showed no significant dissection (Figure 1C). In addition, five of the scores induced by the NSE PTA balloon were detected by optical frequency domain imaging (OFDI) (Terumo Corporation, Tokyo, Japan) (Figure 1D).
We previously evaluated the efficacy of NSE three inflations to reduce the severe dissection in the treatment of femoropopliteal lesions [1]. In that study, when the NSE three inflations performed with a NSE PTA balloon, the elements shift of NSE PTA balloon could detect in vitro experiment, while could not in patients with intravascular ultrasound (IVUS) due to the insufficient resolution of IVUS.
The resolution of OFDI is approximately 10 times greater than that of IVUS [2], OFDI could detect the scores induced by the NSE PTA balloon. Moreover, OFDI detected five scores after the NSE three inflations. Because the NSE PTA balloon has three elements, the image of OFDI proved the elements shift of the NSE PTA balloon when the NSE three inflations was performed in a patient.