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[Clinical results of directional peripheral atherectomy]
1Department of Cardiovascular Surgery, Fukushima Medical College, Japan.
Insights
Directional peripheral atherectomy (DPA) shows high initial success rates for treating peripheral artery disease. This minimally invasive technique offers promising long-term patency for stenotic and occlusive lesions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Peripheral artery disease (PAD) poses a significant clinical challenge, necessitating effective revascularization strategies.
- Directional peripheral atherectomy (DPA) is an endovascular technique for removing atherosclerotic plaque.
- Evaluating the clinical outcomes of DPA is crucial for optimizing PAD treatment algorithms.
Observation:
- A total of 81 lesions in 57 patients were treated with DPA between 1996 and 1996.
- Lesions included 56 stenotic and 25 occlusive types, with varying severity.
- Simpson AtheroTrackTM devices were utilized, sometimes in conjunction with Nd-YAG laser angioplasty (LAP) for complex lesions.
Findings:
- High initial clinical success rates were achieved: 98% for stenotic lesions and 96% for occlusive lesions.
- Late success rates at a mean follow-up of 28 months were 86% for both lesion types.
- Minor dissections related to LAP were the only reported complications.
Implications:
- DPA demonstrates considerable efficacy and safety in treating a range of peripheral artery lesions.
- The technique holds potential for further clinical application with continued improvements in device technology and procedural techniques.
- Optimizing DPA may enhance both initial and long-term patency rates, improving patient outcomes in PAD management.
Abstract:
I will report clinical results of directional peripheral atherectomy (DPA). DPA was performed in 81 lesions in 57 cases in our department in the period ending February 1996 (56 men and one women, age; 24-85 years old, and mean age; 67 years old). 56 stenotic lesions and 25 complete occlusive lesions were observed. Simpson AtherotrackTM from six to nine Fr was used according the degree of lesions. In the complete occlusive or severe stenotic lesions DPA was carried out only after laser angioplasty (LAP) by using Nd-YAG laser. Initial clinical success was defined as < 30% residual stenotic rate by arteriography. In cases with more than 30% residual stenosis, we performed reDPA, balloon angioplasty or stent implantation. The initial success rate was 98% in the stenotic group and 96% in the occlusive group. Five complications occurred and all complications were minor dissection caused by minor dissection caused by LAP. The late success rate was 86% in the stenotic group and 86% in the occlusive group (observation period; 1-46 mena; 28 months). This new technique might have further clinical application with improvement of the initial and long patency rate.