We aimed to investigate the effectiveness of a scoring balloon catheter in expanding a circumferentially calcified lesion compared to a conventional balloon catheter using an in vitro experiment setting and elucidate the underlying mechanisms of this ability using a finite element analysis. True efficacy of the scoring device and the underlying mechanisms for heavily calcified coronary lesions are unclear. We employed a Scoreflex scoring balloon catheter (OrbusNeich, Hong Kong, China). The ability of Scoreflex to dilate a calcified lesion was compared with a conventional balloon catheter using 3 different sized calcium tubes. The thickness of the calcium tubes were 2.0, 2.25, and 2.5 mm. The primary endpoints were the successful induction of cracks in the calcium tubes and the inflation pressures required for inducing cracks. The inflation pressure required for cracking the calcium tubes were consistently lower with Scoreflex (p < 0.05, Student t test). The finite element analysis revealed that the first principal stress applied to the calcified plaque was higher by at least threefold when applying the balloon catheter with scoring elements. A scoring balloon catheter can expand a calcified lesion with lower pressure than that of a conventional balloon. The finite element analysis revealed that the concentration of the stress observed in the outside of the calcified plaque just opposite to the scoring element is the underlying mechanism of the increased ability of Scoreflex to dilate the calcified lesion.
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The authors would like to thank Mr. Kenataro Takenaka and Prof. Taiji Adachi for their great advice and suggestions in the finite element analysis. Special thanks also go to Ms. Rika Sugiura, Ms. Hiromi Yoshida, and Ms. Yoko Shimizu for their secretarial supports.
Conflict of interest
The Scoreflex and Sapphire balloon catheters were supplied by OrbusNeich Japan. None of the authors have identified a conflict of interest.
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Kawase, Y., Saito, N., Watanabe, S. et al. Utility of a scoring balloon for a severely calcified lesion: bench test and finite element analysis. Cardiovasc Interv and Ther 29, 134–139 (2014) doi:10.1007/s12928-013-0232-6
- Calcified lesion
- Scoring balloon
- Finite element analysis
- Complex lesion
- Balloon angioplasty