Related Experiment Videos
[Reopening chronic arterial occlusions]
C Vallbracht1, D Liermann, H Landgraf
1Abt. für Kardiologie, Universität Frankfurt a. M.
Insights
Low speed rotational angioplasty (ROTACS) effectively treats chronic occlusions in peripheral and coronary arteries. This technique offers high success rates and comparable long-term results to conventional methods, with no reported deaths.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Chronic total occlusions (CTOs) pose significant challenges for percutaneous transluminal angioplasty in both peripheral and coronary vasculature.
- Conventional angioplasty techniques often face limitations in successfully recanalizing these complex lesions.
Purpose of the Study:
- To evaluate the efficacy and safety of low speed rotational angioplasty (ROTACS) for treating chronic total occlusions.
- To compare the outcomes of ROTACS with conventional angioplasty methods in peripheral and coronary arteries.
Main Methods:
- Retrospective analysis of over 300 peripheral and 200 coronary artery interventions using ROTACS.
- ROTACS was employed as a primary treatment or after failure of conventional techniques.
- Angiographic assessment of acute and long-term success rates, and monitoring for adverse events.
Main Results:
- Acute success rates for ROTACS in peripheral occlusions exceeded 80% as a primary approach and over 60% after conventional failure.
- In coronary occlusions, where ROTACS was used after prior conventional technique failure, acute success reached 70% following a learning curve.
- No deaths were reported in either patient group (peripheral or coronary).
- Long-term angiographic results for ROTACS were comparable to conventional balloon angioplasty.
Conclusions:
- Low speed rotational angioplasty (ROTACS) is a valuable tool for improving recanalization rates in chronic total occlusions of peripheral and coronary arteries.
- ROTACS demonstrates a favorable safety profile and effective long-term outcomes, offering an alternative to conventional treatments.
- The technique has expanded indications in peripheral vasculature, including iliac arteries, with ongoing investigation for other applications.
Abstract:
Chronic complete occlusions still represent the major technical limitation of percutaneous transluminal balloon angioplasty, both in peripheral and coronary vessels. The clinical use of low speed rotational angioplasty (ROTACS) started in 1986 for the peripheral and in 1987 for the coronary vessels, and has already become part of the clinical routine in several centers. Up to now, more than 300 patients with peripheral and more than 200 patients with coronary occlusions were treated in Frankfurt. In peripheral occlusions the acute success rate was more than 80% if used as the first attempt; after failure of conventional techniques still more than 60% of the vessels could be recanalized successfully. In addition to occlusions of the arteries of the lower limbs, the indication now includes the iliac artery and several other indications are under investigation. In each of the patients with chronic coronary occlusions an attempt with conventional techniques had failed before. Following a learning curve, which was also influenced by a better understanding of morphological preconditions, the acute success rate has now reached 70%. Both in patients with peripheral and those with coronary occlusions no deaths occurred. First angiographically documented long-term results in both indications are comparable to conventional balloon angioplasty. It is concluded that the use of low speed rotational angioplasty (ROTACS) can improve the results of nonoperative invasive treatment, both in peripheral and in coronary arteries.