Fracking Technique: The Novel Approach To Crack Deep Calcified Plaque In Common Femoral Artery With Hydraulic Pressure.

Abstract

\n Background:The patency of conventional peripheral intervention for atherosclerotic lesions in common femoral artery (CFA), called “no stenting zone”, are not superior to surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA provide the better clinical outcome compared to standard balloon angioplasty. Atherectomy devices, which focus on modification of superficial calcification, contribute to the improvement of clinical outcomes. However, deep calcium resists vessel expansion so that luminal gain is not easily achieved. Main text:We propose a novel calcified plaque modification technique, named the” Fracking technique”. The term fracking refers to how a rock is fractured apart by the high hydraulic pressure. This technique is to crack deep calcification with hydraulic pressure with a balloon indeflator through 18-gauge needle, which punctures into calcification in order to obtain larger acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in right CFA. Conventional balloon angioplasty for the lesion provided the suboptimal minimal lumen area (MLA) from 6.2 to 10.7mm2 with intravascular ultrasound (IVUS) measurement. Fracking technique was implemented to obtain the larger MLA. After fracking was repeated three times until there were no more Fracking points, a much larger MLA of 27.1mm2 was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis presented with ischemic rest pain of his right limbs due to severe stenosis with eccentric calcification in distal CFA to proximal superficial femoral artery. MLAs with IVUS before and after ballooning were 10.0mm2, 13.1mm2, respectively. None of the results of MLA lived up to our expectation. Fracking technique was attempted, and MLA of 28.9mm2 was successfully obtained after this technique. No complications observed. Conclusions:Fracking technique was effective for severe calcified lesion in CFA to obtain significantly larger lumen area which will lead to long-term patency superior to conventional peripheral intervention.