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Percutaneous peripheral rotational ablation using the Rotablator: immediate and mid term results. Single center
1Cardiology and Surgical Intervention Unit, Polyclinic, Essey Les Nancy, France.
Abstract:
In order to assess the role of percutaneous peripheral rotational ablation using Rotablator (PPRA), 95 symptomatic patients (58 M, 37 F, m. age: 77 +/- 1 y) (r: 50-90 y) having 146 peripheral vascular lesions (PVL) were treated by PPRA. 59% were below the knee and 41% above. The runoff status (n of distal leg art. involved) was as follows: 3:52 pts, 2:23 pts, 1:14 pts, 0:6 pts. The femoral lesions were significantly longer than those at other sites (5.27 +/- 0.43 vs 2.97 +/- 0.3 cm) (p < 0.001). The mean length was 3.73 +/- 0.26 cm (r: 1-20 cm). Complementary PTA was significantly (p < 0.001) more frequent in femoro-popliteal (32 PTA/48 Fem, 5 PTA/12 Pop) than in distal leg lesions (10/86.). RESULTS. After PPRA alone (99 PVL) the stenosis % decreased from 81 +/- 0.75 to 18 +/- 1.1. The residual stenosis was greater at femoral (26 +/- 2.3%) than at distal leg level (16 +/- 1.2%) (p < 0.01). Complementary PTA (47 PVL) lowered residual stenosis from 44% to 13%. 52 complications (spasm, perforation, dissection, distal emboli, no reflow, others) were cured in 47 PVL. Thus our primary technical success per PVL was 97% and per pt 95%. The mean follow-up period was 11 +/- 1 mths (r: 1-37 m). Among 78 pts having a follow-up period > or = 4 mths, 74 pts representing 115 treated PVL underwent an angiography control (2 deaths, 2 lost for follow-up). 87 lesions (76%) showed no restenosis and 28 lesions (34%) showed restenosis of 83 +/- 2.4% (r: 50-100%). The restenosis rate was higher in femoral (12/21: 36%) than in distal (15/58: 21%) or popliteal arteries (1/8: 12%). Restenosis was more frequent for PVL > or = 7 cm (67% vs 16%) (p < 0.001) at all sites. This result together with the complication rate would seem to indicate that lesions > or = 6.7 cm would be a limitation for PPRA. CONCLUSIONS. In our experience Percutaneous Peripheral Rotational Ablation has taken a pre-eminent position in the treatment of distal leg arteries. Our results lead us to broaden its indications to complex vascular lesions. The possibility of runoff treatment should allow an improvement in the long-term patency of PTA and bypass grafts.
Insights
Percutaneous Peripheral Rotational Ablation (PPRA) effectively treats peripheral vascular lesions, especially in distal leg arteries, with high technical success and good long-term patency. Longer lesions (>7 cm) may present limitations for PPRA.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Peripheral vascular lesions (PVL) significantly impact patient mobility and quality of life.
- Traditional treatments for PVL can be invasive with associated risks.
- Rotablator (PPRA) offers a minimally invasive approach for PVL treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of Percutaneous Peripheral Rotational Ablation (PPRA) for treating symptomatic peripheral vascular lesions (PVL).
- To assess the technical success, complication rates, and long-term outcomes of PPRA in a diverse patient cohort.
- To identify factors influencing restenosis and determine optimal indications for PPRA.
Main Methods:
- A prospective study involving 95 patients with 146 PVL treated with PPRA.
- Lesions were categorized by location (above/below knee) and length, with runoff status documented.
- Complementary percutaneous transluminal angioplasty (PTA) was utilized as needed, and outcomes were assessed via angiography.
Main Results:
- PPRA achieved a high primary technical success rate of 97% per lesion and 95% per patient.
- Mean stenosis decreased significantly from 81% to 18% post-PPRA alone.
- Restenosis rates were higher for longer lesions (≥7 cm) and in femoral arteries, suggesting potential limitations.
Conclusions:
- PPRA is a valuable tool for treating PVL, particularly in distal leg arteries, demonstrating high technical success.
- The technique shows promise for complex vascular lesions and may improve long-term patency of PTA and bypass grafts.
- Lesion length greater than or equal to 6.7 cm appears to be a limitation for PPRA, warranting further investigation.