New balloon reduces contrast use by combining dilatation and fluid delivery

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At the Leipzig Interventional Course (LINC, 27–30 January, Leipzig, Germany), Michael Lichtenberg, chief of the Vascular Center Klinikum Arnsberg, Arnsberg, Germany, presented information about a new balloon dilatation catheter that allows a targeted injection of fluids during percutaneous transluminal angioplasty.

In the talk titled “Using Arrow GPS Cath to protect with placement, reduce fluoroscopy while minimising contrast” Lichtenberg noted that it is widely known that the use of contrast represents a risk to patients with kidney disease and is a risk factor for radiocontrast-induced nephropathy. An alternative is the use of carbon dioxide angiogram but, he told delegates, it can be painful, the visualisation of the morphology is low in comparison with contrast, a high-frame rate is needed as well as radiation, and a CO2 package is costly. He added, “It is also a problem in lower body imaging because of bowel gas, and also involves image postprocessing; therefore, I am not a fan of carbon dioxide angiogram.”

The Arrow GPS Cath (Teleflex) is a new, two-in-one technique balloon with a flushing concept. Lichtenberg explained: “On one hand, you can perform angioplasty with a semi-compliant balloon; on the other hand, in the same device you have a fluid delivery mode with the VisionValve feature proximal to the balloon—this is used to deliver fluid injections while securing guidewire position so you do not need to take out the wire for flushing.”

He showed a case of a 39-year-old male patient with stenosis in the superficial femoral artery who was suffering from glomerulonephritis and had severe kidney problems (glomerular filtration rate 25ml/min). Lichtenberg injected contrast close to the lesion using VisionValve and used 2ml contrast (complete volume of 3ml). “This allows you to see the high grade stenosis and you can do an overlay roadmap with the balloon inflated. In this case, we ended up with 18.3ml of contrast,” he said.

The device is also helpful for chronic total occlusion recanalisation as the operator does not have to take the catheter out when looking for the right wire for this indication. “You can inject contrast through the VisionValve to find the way you want to go with the wire. This helps shorten the time to find your way through the lesion and decreases the need for more contrast injection,” Lichtenberg said.

The device consists of a 4F balloon system with a braided shaft. It has a 150cm shaft length, tapered tip profile and a burst pressure of 14atm. It is available in diameters starting at 1.5mm and going up to 7mm. “The device has improved pushability and you can use it from the superficial femoral artery until the most distal part of the lower extremity,” he said.

In conclusion, Lichtenberg commented, the Arros GPS Cath “is a two-in-one system that helps reducing contrast dye use, radiation exposure and fluoroscopy time during procedure. It has the potential to keep the wire in place, and because of this it has advantages especially below the knee as a chronic total occlusion balloon.”

Lichtenberg said that he looks forward to an upcoming registry that will assess how this device will work in daily routine practice.