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

## TL;DR

A new scoring balloon used in artery treatment unexpectedly shifted its scoring site, creating more incisions than intended.

## Contribution

The report highlights a novel scoring balloon design and an unintended site shift phenomenon observed during its use.

## Key findings

- The Aperta NSE balloon created multiple scoring incisions due to a site shift during inflation.
- An in vitro experiment confirmed the scoring site shift phenomenon.
- The shift was likely due to uneven balloon rewrapping rather than a controlled mechanism.

## Abstract

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.