Successful treatment of multi-level PAD with the Diamondback 360® Peripheral Orbital Atherectomy System Exchangeable Series device offers multiple cartridges that can be exchanged on a single device to optimally select crown sizes for individual lesions.

JOHN DAVID CORL, MD

A 71-year-old male patient presented BACK-LOADABLE allows you to exchange wires with a non-healing ulcer on the bottom of while leaving the device in place his left foot, which had not healed for over three months. Angiography was performed GlideAssist® MODE enables the crown to spin at on the left leg via ultrasound-guided access a slow speed (5k RPM), reducing friction to facilitate * in the right common femoral artery (CFA), tracking and provide easier removal of the device *CSI Data on File which showed focal stenosis in the proximal popliteal artery (Figure 1). The lower part IMPROVED ACCESS offers different crowns to of the left leg showed two-vessel runoff treat different vessel sizes by exchanging cartridges through the peroneal and anterior tibial artery. The left posterior tibial artery, which supplies blood flow to the area of confirmed dense calcification throughout 10). Repeat angiographic images were made the ulcer, was heavily calcified (Figure 2). the left popliteal artery with severe stenosis after the successful orbital atherectomy and It showed 100% blockage proximally, with in the proximal left popliteal artery balloon angioplasty (Figure 11). chronic total occlusion (CTO) extending (Figures 6 and 7). The posterior tibial artery and plantar into the left foot's plantar arteries (Figures The Diamondback 360 Exchangeable artery were further treated with balloon 3 and 4). Series with GlideAssist® was selected angioplasty using a 2x20 balloon and The right CFA sheath was exchanged for optimal crown sizing to address the a 3.0x210 tapered balloon (Figure 12). for a 6 Fr sheath. A 0.014" guide wire was multilevel PAD. A 1.25 Micro Crown was Afterward, angiographic images of the advanced into the left posterior tibial used in the popliteal artery and throughout left posterior tibial artery (Figure 13) and artery. Using multiple guide wires, a 0.014" the left posterior tibial artery (Figure 8). plantar artery (Figure 14) were performed support catheter was successfully advanced Multiple orbital atherectomy passes were through the balloon catheter. across the long CTO in the left posterior performed at low, medium and high speed. After the successful procedure, with tibial artery and into the true lumen of the The Diamondback 360 Peripheral OAS ongoing wound care, the ulcer on the plantar artery. The guide wire was removed, was then removed using the GlideAssist patient’s left foot healed. and selective angiography images of the feature, and the 1.25 Micro Crown was plantar artery were performed through the exchanged for a 2.00 Solid Crown. Orbital CSI’s Diamondback 360 Peripheral support catheter to confirm an intra-lumen atherectomy was then performed in the Orbital Atherectomy System Exchangeable location (Figure 5). A ViperWire Advance® left popliteal artery (Figure 9). Afterward, Series was designed to optimally treat Peripheral Guide Wire with Flex Tip was using GlideAssist, the Diamondback 360 multi-level disease in one procedure. Now advanced through the support catheter and Peripheral OAS was removed. more than ever it’s imperative that we treat the support catheter was removed. these patients while minimizing time spent The proximal left popliteal artery was in the hospital. Intravascular ultrasound was performed then treated with prolonged balloon on the left popliteal artery. The images angioplasty using a 6x40 balloon (Figure

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Dr. Corl is a consultant of Cardiovascular Systems, Inc. (CSI). CSI® sponsored the placement of this article. Indication: The Diamondback 360® Peripheral Orbital Atherectomy System Exchangeable Series is a percutaneous orbital atherectomy system indicated for use as therapy in patients with occlusive atherosclerotic disease in peripheral arteries and stenotic material from artificial arteriovenous dialysis fistulae.Important Safety Information: The System is contraindicated for use in coronary arteries, bypass grafts, stents, or where thrombus or dissections are present. Although the incidence of adverse events is rare, potential events that can occur with atherectomy include: pain, hypotension, CVA/TIA, death, dissection, perforation, distal embolization, thrombus formation, hematuria, abrupt or acute vessel closure, or arterial spasm. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. CSI, Diamondback 360, ViperWire Advance and GlideAssist are registered trademarks of Cardiovascular Systems, Inc. © 2021 Cardiovascular Systems, Inc. EN-6686.A 0221