Tsujimura Takuya, Ishihara Takayuki, Osamu Iida, Yoshida Motoshi, Nakazato Taro, Ozaki Tatsuya, Asai Mitsutoshi, Masuda Masaharu, Okamoto Shin, Nanto Kiyonori, Matsuda Yasuhiro, Hata Yosuke, Uematsu Hiroyuki, Higashino Naoko, Nakao Sho, Kusuda Masaya, Kitabayashi Katsukiyo, Mano Toshiaki
Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan.
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
J Cardiol Cases. 2024 Apr 16;30(1):20-23. doi: 10.1016/j.jccase.2024.03.003. eCollection 2024 Jul.
An 83-year-old woman with claudication in the right lower extremity was referred to our hospital. Since angiography showed severe stenosis with a severely calcified lesion extending from the ostial to proximal part of the right superficial femoral artery (SFA), endovascular therapy (EVT) with the Jetstream™ atherectomy system (Boston Scientific, Marlborough, MA, USA) and paclitaxel-coated balloon (PCB) was performed. Atherectomy was performed using the Jetstream™ atherectomy catheter SC 1.85, followed by an additional atherectomy using the Jetstream™ atherectomy catheter XC 2.1/3.0. Subsequently, angiography and intravascular ultrasound (IVUS) images showed the enlargement of lumen area due to the reduction of calcified plaque, but even some of the healthy media on the side free of calcified plaque had been removed. Next, a PCB dilation was performed, and the final angiography showed adequate dilation. However, the symptoms recurred 9 months after EVT. Angiography revealed an enlarged vessel suggestive of pseudoaneurysm at the ostial part of the right SFA and severe stenosis distal to the enlarged vessel. IVUS images showed a pseudoaneurysm and severe stenosis due to calcified nodules distal to the pseudoaneurysm. This case suggests that pseudoaneurysm is a potential complication of EVT with the Jetstream™ atherectomy system and PCB for SFA lesions.
The Jetstream™ atherectomy system (Boston Scientific, Marlborough, MA, USA) has developed to improve outcomes for femoropopliteal artery lesions with severely calcified lesions in lower extremity arterial disease by removing calcified plaque and improving vascular compliance. Several clinical reports demonstrated durable patency rates and low complication rates after endovascular therapy using the atherectomy device. However, pseudoaneurysm is a potential complication of endovascular therapy with the Jetstream™ atherectomy system.
一名83岁右下肢间歇性跛行的女性被转诊至我院。由于血管造影显示严重狭窄，且有一个严重钙化病变从右侧股浅动脉（SFA）开口处延伸至近端，遂使用Jetstream™斑块旋切系统（美国马萨诸塞州马尔伯勒市波士顿科学公司）和紫杉醇涂层球囊（PCB）进行了血管内治疗（EVT）。使用Jetstream™斑块旋切导管SC 1.85进行斑块旋切，随后使用Jetstream™斑块旋切导管XC 2.1/3.0进行额外的斑块旋切。随后，血管造影和血管内超声（IVUS）图像显示，由于钙化斑块减少，管腔面积增大，但即使是无钙化斑块一侧的一些健康中膜也被切除。接下来，进行了PCB扩张，最终血管造影显示扩张充分。然而，EVT术后9个月症状复发。血管造影显示右侧SFA开口处血管增粗，提示假性动脉瘤，增粗血管远端严重狭窄。IVUS图像显示假性动脉瘤以及假性动脉瘤远端因钙化结节导致的严重狭窄。该病例提示，假性动脉瘤是使用Jetstream™斑块旋切系统和PCB对SFA病变进行EVT的潜在并发症。
Jetstream™斑块旋切系统（美国马萨诸塞州马尔伯勒市波士顿科学公司）旨在通过去除钙化斑块和改善血管顺应性，提高下肢动脉疾病中伴有严重钙化病变的股腘动脉病变的治疗效果。多项临床报告显示，使用该斑块旋切装置进行血管内治疗后，通畅率持久且并发症发生率低。然而，假性动脉瘤是使用Jetstream™斑块旋切系统进行血管内治疗的潜在并发症。
