A case report of bycross rotational atherectomy followed by drug-coated balloon angioplasty for deep femoral artery atherosclerotic disease.

BACKGROUND

Endovascular techniques have been proposed as an alternative to open repair for lesions of the femoral bifurcation and origin of the deep femoral artery (DFA). Debulking prior to drug-coated balloon angioplasty might improve the technical success and patency.

CASE PRESENTATION: We report the case of a 51-year-old woman with resting foot pain, bilateral femoropopliteal occlusion, and thrombosis of the right DFA, with severe, diffuse, and heavily calcified atherosclerosis. Under locoregional anesthesia, the DFA lesion was recanalized and a ByCross rotational atherectomy system (ByCross Atherectomy Catheter©, Plusmedica) was used in combination with a drug-eluting balloon (DEB) angioplasty (IN.PACT Admiral©, Medtronic). Successful re-establishment of DFA patency was achieved with no evidence of residual stenosis, recoil or flow-limiting dissections. No periprocedural issues or complications related to the use of the ByCross device were observed. The day after the procedure, the patient was discharged on dual oral antiplatelet therapy. After six months of follow-up the duplex ultrasound demonstrated patency without hemodynamic restenosis.

CONCLUSIONS

The treatment of DFA atherosclerotic disease with ByCross rotational atherectomy has not been previously reported. ByCross rotational atherectomy followed by paclitaxel-coated balloon angioplasty of the DFA appears to be useful in patients at high risk for open repair with severely calcified arterial disease.