A Case of Scoring Site Shift of a Novel Scoring Balloon in a Femoropopliteal Arterial Lesion

Using scoring balloons is an accepted strategy for vessel preparation during endovascular treatment of femoropopliteal arterial lesions, as they create controlled longitudinal incisions that facilitate vessel expansion at lower inflation pressures and reduce the risk of uncontrolled arterial dissection. We report a case of a 74-year-old man with intermittent claudication who underwent endovascular treatment using an Aperta non-slip element (NSE) percutaneous transluminal angioplasty (PTA) balloon, a next-generation scoring balloon with four scoring wires fixed to the balloon surface to prevent slippage. The balloon was inflated three times at the same axial position without shaft rotation. Optical frequency domain imaging (OFDI) demonstrated a circumferential scoring site shift, resulting in up to eight distinct scoring incisions from a four-wire device. This phenomenon was further confirmed in an in vitro experiment. The underlying mechanism was most likely related to uneven balloon rewrapping rather than a controlled or intended effect, and its clinical benefit remains unproven.