Combination of Rotational Atherothrombectomy and Paclitaxel-Coated Angioplasty for Femoropopliteal Occlusion

Aims The aim of this retrospective single-center study was to analyze the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of peripheral artery occlusion. Methods In this study, we identified a total of 42 patients who underwent mechanical thrombectomy using Rotarex catheter at our institution. Procedural outcomes and complications were evaluated. Results The cohort consisted of 42 patients (31 men and 11 women), aged 32–93 years (median 68 years). The number of external iliac artery occlusion was 5, with common femoral artery 5, superficial femoral artery 28, femoral profound artery 2, popliteal artery 12, and brachial artery 2. The causes of occlusion were thrombosis (29 cases, 69%), embolism (6 cases, 14%), and reocclusion after percutaneous intervention (7 cases, 17%). We achieved primary success in 100% of the patients with mechanical thrombectomy, associated with balloon angioplasty (40/42, 95.2%) and stent deployment (16/42, 38.1%). The median time of the interventional procedure was 145 min. We encountered lower percentage of distal embolization (2.4%) and artery dissection (2.4%) during usage of Rotarex catheter in our cohort. Conclusions Rotarex thrombectomy was a useful tool to recanalize occluded vessels with additional treatment such as balloon angioplasty or stent deployment, with a low rate of failures and complications. And prospective studies in this issue are recommended.

Section: Discussionmentioning

confidence: 98%

Percutaneous mechanical thrombectomy using Rotarex catheter in peripheral artery occlusion diseases – Experience from a single center

Liu

Huang

et al. 2018

“…A previous study noted a six-month restenosis rate of 6.9% after Rotarex V R use and DEB deployment. 13 Important issues for preference of atherectomy in our institute are lesion length and calcification. Our preference can be explained by the fact that longer and calcific lesions contain more stenotic material; hence, atherectomy system is better able to reduce this material than other techniques combining with DEB or Supera V R .…”

Section: Discussionmentioning

confidence: 99%

Comparison of drug-eluting balloon angioplasty with self-expanding interwoven nitinol stent deployment in patients with complex femoropopliteal lesions

Teymen

Aktürk

et al. 2017

Objective The aim of this study was to compare the drug-eluting balloon with self-expanding interwoven nitinol stent deployment in patients with complex femoropopliteal lesions. Methods We retrospectively identified patients at our clinic with complex femoropopliteal artery lesions treated either with self-expanding interwoven nitinol stent or drug-eluting balloon. All patients had ankle-brachial index measured before and after the intervention, and regular clinical follow-up with Doppler ultrasonography was performed at six months and one year. Patients underwent peripheral angiography if needed. Results From April 2012 to July 2015, 107 patients with complex femoropopliteal lesions treated with using self-expanding interwoven nitinol stent ( N = 49, mean length 143.5 mm, mean follow-up of 14.1 ± 3.7 months) or drug-eluting balloon ( N = 58, mean length 140.6 mm, mean follow-up of 13.8 ± 4.1 months). The technical success rate was 100% in Supera® and 96.6% in drug-eluting balloon group. There were seven restenosis in self-expanding interwoven nitinol stent (SUS) group (84.8% patency) and 11 restenosis in drug-eluting balloon group (79.2% patency). A significant increase in the ankle-brachial index in both groups after intervention demonstrated a hemodynamic success (SUS group 0.45 ± 0.06, drug-eluting balloon group 0.43 ± 0.07). The mean Rutherford Becker Class significantly decreased in both groups after a follow-up of 12 months (SUS group 0.70 ± 0.73, drug-eluting balloon group 0.74 ± 0.75). Conclusion Deploying drug-eluting balloon or self-expanding interwoven nitinol stent in patients with complex femoropopliteal lesions are both safe and effective with high patency rates with no statistical difference for one-year primary patency rates between them.

“…30,31 However, restenosis rates have been reported to range from 18% to 54% after atherectomy procedures in acute and subacute occlusions of the FP artery. 32,33 In addition, a previous study reported a 6-month restenosis rate of 6.9% following the combined use of the atherectomy+DCB. 33 In the follow-up period, we encountered re-occlusion in three patients (7.5%) (n = 2 at 2 months and n = 1 at 4 months).…”

Section: Discussionmentioning

confidence: 99%

“…32,33 In addition, a previous study reported a 6-month restenosis rate of 6.9% following the combined use of the atherectomy+DCB. 33 In the follow-up period, we encountered re-occlusion in three patients (7.5%) (n = 2 at 2 months and n = 1 at 4 months). This result can be interpreted similarly to other studies in the literature.…”

Section: Discussionmentioning

confidence: 99%

Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Yiğit

2021

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.