A comparative study of percutaneous atherectomy for femoropopliteal arterial occlusive disease
Yongquan Gu1, Mahmoud B Malas2, Lixing Qi3
1Department of Vascular Surgery, XuanWu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China - 15901598209@163.com.
Insights
Directional atherectomy (DA) effectively treats lower extremity atherosclerotic disease, including de novo and in-stent lesions. This study confirms DA
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- SilverHawk™ directional atherectomy (DA) has been utilized globally since 2003 for lower extremity atherosclerotic occlusive disease.
- Over 300,000 cases worldwide demonstrate the established use of this technology.
- The study focuses on evaluating DA for symptomatic femoral popliteal atherosclerotic disease.
Purpose of the Study:
- To analyze the safety and effectiveness of directional atherectomy (DA) in treating symptomatic femoral popliteal atherosclerotic disease.
- To assess outcomes across different lesion types, including stenosis, occlusion, in-stent restenosis, and stent occlusion.
Main Methods:
- Retrospective analysis of clinical data from consecutive patients treated with SilverHawk™ plaque excision.
- Lesions were categorized into four types: type I (stenosis), type II (occlusion), type III (in-stent restenosis), and type IV (stent occlusion).
- Technical success rates, plaque capture, and follow-up outcomes were evaluated.
Main Results:
- 160 patients were analyzed, presenting with intermittent claudication, rest pain, or tissue loss.
- High technical success rates were observed across all lesion types (91.7%–98.6%).
- Restenosis rates varied by lesion type (21%–40%), with significantly lower rates in type I compared to types III and IV. Tissue loss patients showed good response to revascularization. Four patients with in-stent thrombosis underwent successful DA after thrombolysis.
Conclusions:
- Percutaneous directional atherectomy (DA) demonstrates safety and effectiveness for both de novo and in-stent atherosclerotic lesions.
- Catheter-directed thrombolysis prior to plaque excision is recommended for in-stent thrombosis.
- DA is a viable treatment option for complex femoral popliteal atherosclerotic disease.
Background:
SilverHawk™ directional atherectomy has been used to treat more than 300 thousand cases of lower extremity atherosclerotic occlusive disease in the world since it was approved by FDA in 2003. This study aimed to analyze the safety and effectiveness of symptomatic femoral popliteal atherosclerotic disease treated by directional atherectomy (DA).
Methods:
Clinical data of all consecutive patients treated with percutaneous atherectomy utilizing the SilverHawk™ plaque excision was retrospectively analyzed. The anatomic criteria of the atherosclerotic lesions were divided into four types: type I stenosis; type II occlusion; type III in-stent restenosis; type IV stent occlusion.
Results:
There were 160 patients treated during the study period. Intermittent claudication in 75 patients (47%), rest pain in 55 patients (34.5%) and tissue loss in 30 patients (18.5%). The number of patients was 72, 15, 49 and 24 in type I, II, III and IV lesions, respectively. Technical success rate was 98.6%, 93.3%, 97.9% and 91.7% in type I, II, III and IV lesions, respectively. Debris of intimal plaque was captured by protection device in 92 patients (71.3%). The mean follow-up period was 23.5±10.4 months. Restenosis rate of type I to IV lesions was 21%, 36%, 36% and 40% respectively. Restenosis rate in type I lesion was significantly lower than that in type III and IV lesions (P<0.05). Patients with tissue loss responded to revascularization as follow: type I, 11/13 healed or reduced (84.6%), type II, 3/3 patients improved (100%), type III, 5/6 patients improved (83.3%) and type IV 4/4 healed (100%). In type IV group, four patients had in-stent thrombosis found by postoperative Duplex ultrasonography. They all underwent DA after catheter-directed thrombolysis with good angiographic results.
Conclusions:
Percutaneous DA is safe and effective for both de-novo atherosclerotic and in-stent stenotic or occlusive lesions. Thrombolysis before plaque excision is recommended in case of in-stenting thrombosis.
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