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Percutaneous peripheral atherectomy: angiographic and clinical follow-up of 60 patients
A von Pölnitz1, A Nerlich, H Berger
1Department of Medicine, Klinikum Grosshadern, Munich, Federal Republic of Germany.
Insights
The Simpson atherectomy catheter safely and effectively treated peripheral vascular disease, showing significant stenosis reduction and maintained artery patency at one year. This method is particularly beneficial for eccentric stenoses.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Peripheral vascular disease (PVD) significantly impacts patient mobility and quality of life.
- Atherectomy offers a minimally invasive approach to treat arterial stenoses and occlusions.
- The Simpson atherectomy catheter is a device used for plaque removal in peripheral arteries.
Purpose of the Study:
- To evaluate the safety and efficacy of the Simpson atherectomy catheter for treating PVD.
- To assess the procedural success rates and long-term outcomes in patients with femoropopliteal and iliac artery lesions.
- To determine the effectiveness of atherectomy in relation to lesion type (stenosis vs. occlusion) and morphology (concentric vs. eccentric).
Main Methods:
- A prospective study involving 60 patients with 94 lesions (63 stenoses, 31 occlusions) in the superficial femoral, popliteal, iliac, and anterior tibial arteries.
- Treatment was performed using the Simpson atherectomy catheter.
- Outcomes were assessed through immediate angiographic success, clinical success, lesion morphology changes, restenosis rates, and 1-year clinical follow-up including Doppler index and walking distance.
Main Results:
- Immediate angiographic success rate was 90% for both stenoses and occlusions.
- Clinical success was achieved in 82% of patients.
- Significant reduction in stenosis severity was observed: from 83% to 17% acutely and 31% at 6 months for stenoses; from 100% to 9% acutely and 60% at 6 months for occlusions.
- Angiographic restenosis occurred in 24% of lesions, with higher rates in total occlusions (47%) compared to eccentric (11%) and concentric (23%) stenoses.
- At 1 year, 72% of patients maintained clinically patent arteries with improved Doppler index and walking distance.
- Repeat atherectomy showed a high rate of secondary restenosis (3 out of 4 patients).
Conclusions:
- The Simpson atherectomy catheter is a safe and effective treatment option for peripheral vascular disease.
- The procedure demonstrates particular benefit in treating eccentric stenoses and is not limited by calcification.
- While effective, restenosis remains a concern, especially after repeat procedures and in total occlusions.
Abstract:
The Simpson atherectomy catheter was used to treat 60 patients with a total of 94 lesions comprising 63 stenoses (mean length 1.1 +/- 0.5 cm) and 31 occlusions (4.2 +/- 2.9 cm) of the superficial femoral (n = 77), popliteal (n = 8), iliac (n = 8) and anterior tibial (n = 1) arteries. The immediate angiographic success rate was 90% for both occlusions and stenoses, and clinical success was obtained in 82% of patients. The stenoses were reduced from 83 +/- 13% to 17 +/- 18% acutely and to 31 +/- 26% at 6 months; the occlusions were reduced from 100% to 9 +/- 9% initially and to 60 +/- 34% at 6 months. Angiographic restenosis was found in 24% of lesions: 23% in concentric and 11% in eccentric lesions and 47% in total occlusions. At 1 year, 72% of patients had clinically patent arteries with maintained Doppler index and walking distance. Three of four patients undergoing repeat atherectomy had a second restenosis. In summary, the procedure was found to be safe and effective in the treatment of peripheral vascular disease. It appears to be particularly beneficial in the treatment of eccentric stenoses and is not limited by the presence of calcification.