One-Year Outcomes Following Directional Atherectomy of Infrapopliteal Artery Lesions

Rastan, Aljoscha; McKinsey, James F.; Garcia, Lawrence A.; Rocha‐Singh, Krishna; Jaff, Michael R.; Harlin, Stuart A.; Kamat, Suraj; Janzer, Sean; Zeller, Thomas

doi:10.1177/1526602815608610

Cited by 48 publications

(26 citation statements)

References 15 publications

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“…DCA has potential advantage in reducing residual plaque volume with combined use of IVUS and the appropriate understanding, as well as in obtaining targeted plaque by tissue [4–6]. The complications of prior DCA device included coronary perforation, dissection, and deforming implanted stent [3, 7]; although DCA device has been renewed and the availability is limited to a specific country, this report is of potential importance for theoretically possible distal embolization of artificial materials caused by any debulking devices [8]. …”

Section: Discussionmentioning

confidence: 99%

Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy

Hamaya

Yonetsu

Ichijo

et al. 2017

Case Reports in Cardiology

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Percutaneous directional coronary atherectomy (DCA) is a plaque debulking method performed in Japan, and recently a renewed DCA device has been launched. We present a case with a tight left anterior descending lesion undergoing percutaneous coronary intervention with application of DCA. After several sessions of DCA, white plaques accompanied by green, stringed materials were obtained from the device; some materials were considerably long (approximately 15 mm in length). A drug-eluting stent was subsequently implanted, and the procedure was completed successfully without any complications. The extracted plaques and artificial materials were pathologically examined, and no inflammatory changes were detected on plaques adjacent to the material. Assessing pathological findings and structure of the DCA catheter, the obtained artificial materials were considered as peeled guidewire, possibly resulting from the friction between the guidewire and metallic bearing in the housing of DCA catheter. Of note, this phenomenon has been recognized even in other DCA cases in which guidewires of the other kind are used. We report this phenomenon for the first time, warning of theoretically possible distal embolization of artificial materials caused by any debulking devices.

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Section: Discussionmentioning

confidence: 99%

Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy

Hamaya

Yonetsu

Ichijo

et al. 2017

Case Reports in Cardiology

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“…Directional atherectomy 장치의 안전성과 효능은 여러 전향적 다기관 연구를 통해 입증되었다( 19 20 21 22 23 24 25 ). Directional atherectomy의 안전성과 효능에 대한 최초의 전향적 다기관 연구는 “Determination of Effectiveness of SilverHawk Peripheral Plaque Excision for the Treatment of Infrainguinal Vessels (이하 DEFINITIVE LE)”인데, 여기에는 미국과 유럽의 50개 기관에서 등록된 파행(claudication) 증상 또는 임계하지허혈(critical limb ischemia; 이하 CLI)이 있는 800명의 환자가 포함되었다( 20 ).…”

Section: 죽종절제술unclassified

Atherectomy in Peripheral Artery Disease: Current and Future

권

김

원

et al. 2021

J Korean Soc Radiol

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죽종절제술은 당뇨병과 만성콩팥병증 등에 의해 발생하는 말초동맥질환에서 유망한 치료법이다. 죽종절제술은 기계적 방법을 통해 죽종 조직을 제거하여 혈관의 내경을 확대하는 것을 말한다. 방법의 특성상 주로 경피적 미세 침습 접근 방식에 국한하여 통용되는 용어이며, 현재 한국에서 사용 가능한 죽종절제술 장치는 두 가지가 있다. 죽종절제술이 성행하면서 “혈관 준비”라는 개념과 “아무것도 남기지 않기”라는 새로운 치료 개념이 대두되었다. 다양한 연구들이 죽종제거술의 안전성과 효용성을 증명하고 있지만 그 한계도 존재하므로, 환자 선택에 신중을 기할 필요가 있고 후속적인 대규모의 연구가 필요하다.

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“…Primary patency was 84% at 1-year follow-up (89.6% for claudicants and 78% for CLI; p = 0.11), while overall freedom from major amputation was 97.1% (100% in claudicants and 93.8% in CLI; p = 0.03). Significant clinical improvements and quality-of-life measurements were noted at 1 year in both claudicants and CLI subgroups [21]. The DEFINITIVE-Ca ++ investigators looked further into the outcomes of directional atherectomy under filter protection for the treatment of moderately to heavily calcified femoropopliteal lesions in particular.…”

Section: Multicenter Prospective Registries and Large Retrospective Cmentioning

confidence: 99%

Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?

Κατσάνος

Spiliοpoulos

Reppas

et al. 2017

Cardiovasc Intervent Radiol

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Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.

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One-Year Outcomes Following Directional Atherectomy of Infrapopliteal Artery Lesions

Abstract: This study demonstrates that directional atherectomy in infrapopliteal arteries results in promising technical and clinical results at 1 year for claudicant as well as CLI patients.

Cited by 48 publications

References 15 publications

Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy

Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy

Atherectomy in Peripheral Artery Disease: Current and Future

Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?

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