Closed-Loop Extracorporeal Vascular Cleaning by Staged Chemical Dissolution

We propose closed-loop extracorporeal vascular cleaning by staged chemical dissolution, a procedure that uses balloon-based topological isolation of an arterial segment to deploy chemistry that cannot be safely used in flowing blood. Within the isolated chamber, sequential stages dissolve calcium (EDTA), lipid (poloxamer/cyclodextrin), and fibrous cap collagen (targeted collagenase). Bidirectional flow prevents diffusion-limited stagnation; the internal elastic lamina serves as a self-stopping boundary preventing medial damage. An iterative protocol with pharmacological mobilization between sessions addresses microvascular sites inaccessible to direct treatment. Six testable predictions are specified for porcine validation. The architecture uses existing FDA-approved components (balloon catheters, extracorporeal circulation) deployed in a novel combination, making the regulatory and clinical translation path substantially shorter than for novel device development.

This manuscript is currently under peer review at Cureus Journal of Medical Science.