Combined HawkOne directional atherectomy and paclitaxel-coated balloon angioplasty for isolated calcified popliteal artery lesion: a no-stent approach to lower extremity endovascular revascularization

Abstract

Restenosis rate after percutaneous transluminal angioplasty (PTA) of isolated calcified popliteal artery lesion makes this endovascular procedure still debated. Indeed, the presence of severe calcification of the atherosclerotic target lesion is responsible for a poor response to balloon dilation, due to significant acute vessel recoil and frequent dissection, limiting technical success rate and long-term patency (1-3). Directional atherectomy (DA) may be an alternative treatment modality that can improve procedural success by debulking fibrocalcific portion of the plaque, but provides benefits in terms of patency rate only when combined with angioplasty (3,4). The use of drug-coated balloons (DCB) for endovascular treatment of the popliteal artery has been demonstrated to reduce the rate of restenosis (4,5). However, no data exist regarding the use of DCB in heavy calcified lesions. In this case, we applied a new endovascular approach for the treatment of isolated calcified popliteal artery lesion, combining DA using the new generation of HawkOne catheter with paclitaxel-coated balloon angioplasty, to prevent long-term restenosis and to avoid the need of stenting.