Severe calcified lesion is one of the toughest cases for EVT. We often use Crosser® for the calcification, however, it can be widened to just 2mm and that is not enough at all. So, we would like to propose a new and aggressive flossing method “Crossvac” which enables us to reduce eccentric calcification, gets enough lesion modification. First, we cross the lesion EVAC (aspiration catheter) and then Crosser® inside. The tip of the EVAC is diagonally curved, twist it to direct the short side toward calcification and move both. We will show the efficacy in our hospital.
First of all, we would like to propose you the “Crossvac” technique. It is the combination of crosser and E-VAC. First, pass through the lesion with the E-VAC and then insert the Crosser inside. The tip of the E-VAC is diagonally curved, so twist it to direct the short side toward the calcification and floss several times. we can choose the side to floss stably, and the other side of it covers the healthy vessel and protect it from perforation. Furthermore, EVAC can also help to straighten the curved vessel, so it makes crosser work better.

We performed 16 cases with the novel method with severe calcified lesion between September 2018 and August 2019. The endpoints were technical and angiographic success rate, the lesion modification of MLA measured by IVUS and the primary patency at three months post procedure.

In results, technical and angiographic success rate were both 100%. We used IVUS in all cases, the lesion modification was significantly larger compared with EVT using only Crosser®. After three months, restenosis and re-occlusion were not observed.

In our conclusions, “Crossvac” is a new and aggressive flossing method which is useful to reduce eccentric calcification, get a enough lesion modification. E-VAC can help straightening curved vessels, so it makes crosser® work better. Also, It expected to make the risk of bleeding complications lower.