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Percutaneous rotational atherectomy in peripheral vascular disease for lesions unsuitable for balloon angioplasty
S Tyagi1, D S Gambhir, S Petkar
1Department of Cardiology, GB Pant Hospital, New Delhi.
Insights
Rotational atherectomy effectively treated severe peripheral artery disease in patients unsuitable for balloon angioplasty. This minimally invasive procedure relieved claudication and showed no restenosis in follow-up, indicating a safe and effective treatment option.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Vascular Disease
Background:
- Severe limb ischemia and claudication significantly impact patient quality of life.
- Certain peripheral artery lesions are challenging for conventional balloon angioplasty.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous rotational atherectomy (Rotablator) for treating complex peripheral artery lesions.
- To assess the outcomes of rotational atherectomy in patients with severe claudication due to lesions unsuitable for balloon angioplasty.
Main Methods:
- Rotational atherectomy using a high-speed burr was performed on 5 patients with superficial femoral or axillary artery obstructions (90-99%).
- Lesions were deemed unsuitable for or failed balloon angioplasty in 4 and 1 patient, respectively.
- Adjunctive balloon angioplasty was used post-rotablation.
Main Results:
- Rotational atherectomy reduced stenosis from 94.6% to 42%.
- Adjunctive balloon angioplasty further decreased residual narrowing to 14% (p < 0.001).
- All patients experienced symptom relief, improved distal pulses, and no restenosis during 5-18 months follow-up; one patient had transient hemoglobinuria.
Conclusions:
- Percutaneous rotational atherectomy is a safe and effective treatment for severe peripheral artery disease.
- The procedure yields gratifying results in patients with complex lesions unsuitable for primary balloon angioplasty.
- Rotational atherectomy offers a viable alternative for improving limb perfusion and alleviating claudication.
Abstract:
Percutaneous rotational atherectomy (Rotablator), a high speed (> 140,000 RPM) rotational burr was used to relieve 90-99 percent obstruction in 3 superficial femoral and 2 axillary arteries. These patients had severe claudication in respective extremities. In 4 patients, the lesion was considered to be unsuitable for balloon angioplasty and one patient underwent rotational atherectomy after failure to cross the lesion with balloon catheter. The burr size used ranged from 1.5 to 2.5 mm. After rotablation, the stenosis was reduced from 94.6 +/- 4.5 percent to 42 +/- 8.4 percent. The residual narrowing was further reduced by adjunctive balloon angioplasty to 14 +/- 5.5 percent (p < 0.001). Except for hemoglobinuria in one patient, there were no complications. All patients had good distal pulsations and were relieved of their claudication. On follow-up of 5-18 months, there has been no restenosis. Thus, our preliminary experience suggests that rotational atherectomy is safe and produces gratifying results in patients with peripheral vascular disease having lesions unsuitable for primary balloon angioplasty.