[Percutaneous peripheral atherectomy in arterial occlusive disease. Angiographic and clinical acute and long-term results]
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P Gonschior1, B Höfling, D Backa
1Medizinische Klinik I, Klinikum Grosshadern, Universität München.
Insights
Percutaneous atherectomy effectively treats challenging peripheral artery disease lesions, including occlusions and eccentric stenoses. This procedure offers good short- and long-term outcomes for patients with severe arteriosclerotic disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Arteriosclerotic lesions in peripheral arteries often present complex morphologies.
- Conventional treatments like balloon angioplasty may be unsuitable for certain lesion types.
Purpose of the Study:
- To evaluate the efficacy and outcomes of percutaneous atherectomy for treating diverse arteriosclerotic lesions.
- To assess both early and long-term results in patients with peripheral artery disease.
Main Methods:
- Percutaneous atherectomy was performed on 130 arteriosclerotic lesions in 80 patients.
- Lesions included iliac, superficial femoral, popliteal, and anterior tibial arteries.
- Patient demographics and lesion characteristics (concentric, eccentric, occlusive) were recorded.
Main Results:
- Excellent early angiographic success (residual stenosis <50%) was achieved in 94% of lesions.
- Mean stenosis decreased from 85% to 12%, with significant improvement in Doppler index (P<0.01).
- At 6-month follow-up, average stenosis was 33%, with a re-stenosis rate of 25%.
Conclusions:
- Percutaneous atherectomy provides favorable short- and long-term results.
- The procedure is effective even for morphologically challenging lesions, including eccentric, calcified, and occlusive types.
- Atherectomy is a viable option for patients with peripheral artery disease unsuitable for conventional angioplasty.
Abstract:
130 arteriosclerotic lesions--10 in the iliac, 109 in the superficial femoral, 10 in the popliteal and 1 in the anterior tibial artery--were treated by percutaneous atherectomy in 80 patients (62 men and 18 women: mean age 65 +/- 10 years). 23 of the lesions were concentric, 65 eccentric stenoses, while 42 were fully occlusive. 32 patients were in stage IIb (after Fontaine), 24 in stage IIa and 12 each in stage III or IV. Most of the stenoses were not suitable for conventional balloon dilatation because of their primary morphology. A good early angiographic result (residual stenosis less than 50%) was achieved in 94% of lesions. Mean stenosis degree was reduced from 85 +/- 12% to 12 +/- 10% (occlusions from 100% to 9 +/- 9%). The Doppler index increased from 0.6 +/- 0.18 to 0.85 +/- 0.15 (P less than 0.01). Follow-up angiography after 6 months in 104 lesions demonstrated an average stenosis degree of 33 +/- 25% (occlusions 44 +/- 28%). 26 of the 104 re-studied lesions fulfilled the criterion for re-stenosis (greater than 50%): six concentric ones and five eccentric ones, as well as 15 occlusions. These findings indicate that peripheral atherectomy can be employed with good short and long-term results even in morphologically unfavourable, markedly eccentric or calcified lesions and occlusions.