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Transluminal atherectomy for occlusive peripheral vascular disease
J B Simpson1, M R Selmon, G C Robertson
1Sequoia Hospital, Redwood City, California.
Insights
Transluminal atherectomy effectively removes atheroma from peripheral arteries, significantly reducing stenosis. Achieving less than 30% residual stenosis is crucial for preventing restenosis and improving long-term outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Occlusive peripheral vascular disease poses significant health risks.
- Atherectomy offers a minimally invasive approach to treat arterial stenosis.
Purpose of the Study:
- To evaluate the efficacy and safety of transluminal atherectomy for peripheral vascular disease.
- To analyze the histopathology of removed atheromatous specimens.
- To determine the impact of residual stenosis on restenosis rates.
Main Methods:
- Sixty-one patients with peripheral vascular disease underwent transluminal atherectomy using various catheter sizes.
- Atheromatous specimens were collected and analyzed histopathologically.
- Angiographic follow-up was conducted at six months to assess restenosis.
Main Results:
- Mean stenosis reduced from 71% to 23% after atherectomy.
- 87% of stenoses were reduced to less than 45%.
- Lower restenosis rates (18%) were observed in patients with <30% residual stenosis compared to those with >30% (52%).
Conclusions:
- Transluminal atherectomy is an effective and safe method for removing atheromatous deposits.
- Complete atherectomy, achieving <30% residual stenosis, is vital for reducing long-term restenosis.
- Histopathologic differences were noted between original and restenotic lesions.
Abstract:
Sixty-one patients with occlusive peripheral vascular disease were treated with transluminal atherectomy, a catheter-mediated technique for removal of atheroma. The technique was performed using 7Fr, 9Fr or 11Fr atherectomy catheters. Mean percent diameter stenosis was reduced from 71 to 23%, by removal of 831 atheromatous specimens in 949 passes of the cutting element through 136 stenoses in 61 patients. All specimens removed were sent for histopathologic examination to determine the components of the atheroma removed, which differed for specimens removed from original vs restenotic lesions. Percent stenosis was reduced to less than 45% in 118 of 136 stenoses (87%). Complications included 1 thrombus, which resolved after intraarterial infusion of streptokinase and 1 probable distal embolization without sequelae. Three angiographic dissections occurred without impairment of blood flow. There were no instances of acute occlusion, vascular spasm or vessel perforation. Six-month follow-up angiography was performed showing that patients who had a residual stenosis less than 30% after initial atherectomy had a lower restenosis rate (18%) than patients with initial residual stenoses greater than 30% (52%); this result demonstrated the importance of performing more complete atherectomy. Transluminal atherectomy appears to be an effective, predictable and safe method for removing occlusive atheromatous deposits from peripheral arteries.