Related Experiment Videos
Pullback atherectomy with the Arrow-Fischell atherectomy device
1Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Insights
The Arrow-Fischell catheter safely removes coronary artery plaque before other procedures. While effective, it yields less tissue than directional atherectomy and has limitations.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Coronary artery disease necessitates plaque removal.
- Atherectomy catheters aim to debulk and retrieve atheroma.
- The Arrow-Fischell device is a pullback atherectomy catheter.
Purpose of the Study:
- To evaluate the safety and efficacy of the Arrow-Fischell pullback atherectomy catheter.
- To assess the feasibility of using this device before balloon angioplasty or stenting.
Main Methods:
- Retrospective analysis of 41 patients undergoing pullback atherectomy.
- The device was used to debulk and retrieve coronary atheroma prior to angioplasty or stenting.
- Success rates, tissue retrieval, and complications were recorded.
Main Results:
- The device successfully crossed target lesions in 93% of patients and obtained tissue in 88%.
- All procedures were completed without major adverse events like myocardial infarction, emergency surgery, or death.
- Complications included significant coronary artery spasm (8 patients), abrupt vessel closure (1 patient), and arterial perforation (2 patients).
Conclusions:
- Pullback atherectomy with the Arrow-Fischell catheter is feasible and can be performed relatively safely.
- The procedure is more technically demanding than balloon angioplasty.
- Tissue retrieval is less than with directional atherectomy, indicating significant limitations for this device.
Abstract:
The Arrow-Fischell pullback atherectomy catheter is designed to circumferentially debulk and retrieve coronary atheroma. We performed pullback atherectomy before balloon angioplasty or stenting in 41 patients. The device crossed the target lesion in 38 (93%) and obtained tissue in 36 (88%). All procedures were completed successfully and without myocardial infarction, emergency cardiac surgery, or death. Complications included major spasm in 8 patients, postprocedural abrupt closure in 1, and otherwise uncomplicated arterial perforation in 2. Pullback atherectomy can be performed relatively safely, but is more difficult than balloon angioplasty, obtains less tissue than directional atherectomy, and is associated with significant limitations.