Longitudinal force focused coronary angioplasty: a technique for resistant lesions

In a small percentage of vascular lesions undergoing angioplasty, the force generated by balloon inflation is insufficient to produce an acceptable deformation of the stenosis. Techniques developed to deal with this problem include the use of laser energy and rotational atherectomy. Use of a guidewire positioned between the dilating balloon and vessel wall has been reported to be effective in resistant heavily calcified lesions. The current case report describes a situation in which two wires between the balloon and the target lesion were required to produce an acceptable reduction in stenosis severity. This technique represents an extension of the single-wire technique and may have relevance to the strategy being explored with the "cutting balloon."