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[Reopening chronic arterial occlusions]
1Abteilung für Kardiologie, Universitätsklinik Frankfurt am Main.
Insights
Low-speed rotational angioplasty (ROTACS) effectively treats chronic occlusions in peripheral and coronary arteries. This technique offers high success rates and improves outcomes for patients when conventional methods fail.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Chronic total occlusions (CTOs) pose significant challenges for conventional percutaneous transluminal balloon angioplasty in both peripheral and coronary circulation.
- The development of alternative techniques is crucial for improving revascularization success rates.
Purpose of the Study:
- To evaluate the efficacy and safety of low-speed rotational angioplasty (ROTACS) for treating chronic total occlusions in peripheral and coronary arteries.
- To assess ROTACS outcomes, particularly in cases where conventional angioplasty has failed.
Main Methods:
- Clinical application of low-speed rotational angioplasty (ROTACS) in over 300 peripheral and 200 coronary artery cases.
- Analysis of acute success rates, revascularization rates after conventional technique failure, and long-term outcomes.
- Monitoring for adverse events such as death or vessel perforation.
Main Results:
- High acute success rates for ROTACS: >80% as a primary approach and >60% after failed conventional attempts in peripheral occlusions.
- Achieved a 70% acute success rate in chronic coronary occlusions, following an initial learning curve.
- No deaths or perforations were reported in either peripheral or coronary interventions.
- Angiographically documented long-term results are comparable to conventional balloon angioplasty techniques.
Conclusions:
- Low-speed rotational angioplasty (ROTACS) is a valuable tool for improving the success of non-operative invasive treatment for chronic occlusions in peripheral and coronary arteries.
- ROTACS demonstrates a favorable safety profile and comparable long-term efficacy to traditional methods, offering a viable alternative for complex cases.
Abstract:
Chronic complete occlusions still represents the major technical limitation of percutaneous transluminal balloon angioplasty, both in peripheral and in coronary vessels. The clinical use of low-speed rotational angioplasty 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 occlusion were treated in Frankfurt. In the 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 the subclavian artery. In each of the patients with chronic coronary occlusions an attempt with conventional techniques had failed earlier. 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 or perforations occurred. First angiographically documented long-term results in both indications are comparable to conventional balloon techniques. 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.