30.

6
Balloons

Emmanouil S. Brilakis, MD, PhD

 PCI: the steps
1. Planning
2. Monitoring
3. Pharmacology
4. Access
5. Engagement
6. Angiography
7. Determine target lesion
8. Wiring
9. Lesion preparation
10. Stenting
11. Closure
12. Physiology
13. Imaging
14. Hemodynamic support
 Balloons

1. Standard Specialty

Compliant
2. Small 8. Intracoronary
Non-compliant lithotripsy
3.Plaque
7.Very high
modification
pressure
4. Trapping 6.Drug coated
5.Ostial Flash
 2. Small balloons
0.85 mm Balloon/microcatheter
Nano Threader

1.0 mm Skived tip

Sapphire Pro Glider
Ikazuchi Zero
Ryurei

1.2-1.5 mm
Standard balloons
Approach to “balloon uncrossable” lesion
“Balloon Uncrossable” lesion

1. Small balloon
2. Rupture balloon in vessel (grenadoplasty) 1st line

Guide catheter
3. Increase support 2nd line
Wire

4. Microcatheter 3rd line

5. Wire “cutting” or puncture
9. Combinations
6. Laser 4th line
7. Atherectomy

External crush
8. Subintimal 5th line
Distal anchor
techniques
Approach to “balloon uncrossable” lesion

1. Small balloon
2. Rupture balloon in vessel (grenadoplasty)
1st line

 Long length (20 mm)

 Rx balloon – more pushable
 Different brands - can alternatively try larger balloons
Sapphire Pro
Threader

1.2x12 mm
Glider
 1. High pressure balloon inflation
• Shorter balloon, 2 smaller balloons together
• With ≥1 buddy wire(s)
2. Modified balloon

Intravascular imaging
• Angiosculpt, Chocolate, Cutting balloon
3. Laser

HOW TO APPROACH IN- 4. Atherectomy

STENT BALLOON - Orbital (for old stents only)
UNDILATABLE LESIONS - Rotational
5. Subintimal lesion crossing
6. CABG
7. Intravascular lithotripsy
Future techniques
8. SIS OPN balloon
 Treating coronary Ca+2
Standard Plaque modification Atherectomy Future
balloons balloons

Angiosculpt
Orbital
NC balloons
Intravascular
lithotripsy
Cutting balloon

Rotational
SIS OPN
Chocolate
Angiosculpt
Deflated

Inflated
Chocolate
 Cutting balloon

0.005 inch atherotomes

• Hard to deliver
• Inflate slow (1atm every 5 sec)
Blimp
4. Trapping balloons

Trapper - BSci
Trap It – IMDS
Kusabi - Kaneka
5. Ostial Flash
 6. Drug-coated balloons

SeQuent® Please NEO

B. Braun Melsunge AG
7. Very-high pressure balloon
8. Intravascular lithotripsy
 Balloons

1. Standard Specialty

Compliant
2. Small 8. Intracoronary
Non-compliant lithotripsy
3.Plaque
7.Very high
modification
pressure
4. Trapping 6.Drug coated
5.Ostial Flash