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Results of directional peripheral atherectomy with reference to histology, histochemistry, and ultrastructure
P Gonschior1, B Höfling, B Mack
1Med. Dept. I, Klinikum Grosshadern, München, Germany.
Insights
Directional atherectomy effectively treats complex peripheral vascular disease, including stenoses and occlusions, with high acute success and good long-term results. This safe therapy is particularly beneficial for challenging lesions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Peripheral vascular disease (PVD) affects numerous patients, often presenting with complex lesions unsuitable for traditional angioplasty.
- Directional atherectomy offers a minimally invasive approach for PVD management.
Purpose of the Study:
- To evaluate the safety and efficacy of directional atherectomy for treating symptomatic peripheral vascular disease.
- To assess the outcomes in patients with complex lesions, including stenoses and occlusions.
Main Methods:
- A cohort of 100 patients with symptomatic PVD underwent treatment with a directional atherectomy catheter.
- 153 lesions (98 stenoses, 55 occlusions) in iliac, superficial femoral, and popliteal arteries were treated.
- Patients were selected due to complexity and unsuitability for balloon angioplasty.
Main Results:
- High acute success rates of 94% were achieved for both stenoses and occlusions.
- Mean stenosis reduction from 85% to 12% for stenoses and 100% to 9% for occlusions.
- Six-month follow-up showed mean stenosis of 33% (stenoses) and 44% (occlusions), with a 20% overall restenosis rate.
Conclusions:
- Directional atherectomy is a safe and effective treatment for symptomatic PVD, yielding good long-term results.
- The procedure demonstrates particular benefit in treating eccentric, complex stenoses, and occlusions.
- Analysis of excised plaque provides insights into arteriosclerosis and restenosis pathogenesis.
Abstract:
One hundred patients with symptomatic peripheral vascular disease were treated with a directional atherectomy catheter; 153 lesions comprising 98 stenoses and 55 occlusions were located in the iliac (n = 22), superficial femoral (n = 114), popliteal (n = 16), and anterior tibial (n = 1) arteries. The majority of these patients were poor candidates for balloon angioplasty because of the complexity of lesions. There were 70 eccentric and 28 concentric lesions and 55 occlusions (mean length 4.2 +/- 2.9 cm). Acute success rate was 94% for both stenoses and occlusions. Four patients were treated in both lower extremities. The stenoses were reduced from 85 +/- 12% to 12 +/- 10% acutely (occlusions 100% to 9 +/- 9%). Six-month angiographic follow-ups were performed in 81% of treated patients, the others refusing angiography. Mean stenosis after six months was 33 +/- 25% (occlusions 44 +/- 28%). Restenosis (> 50%) was found in 20% of treated lesions: 26% in concentric lesions, 8% in eccentric lesions, and 32% in occluded vessels. Treatment of peripheral vascular disease with the atherectomy device is safe and effective therapy with good long-term results. These results were obtained in complex lesions with 55 occlusions. Atherectomy seems to be particularly beneficial in the treatment of eccentric and complex stenoses and is not limited by occlusion or calcification. Furthermore, insight into the pathogenesis of arteriosclerosis and the development of restenosis is enabled by analysis of removed plaque material.