Results of Directional Peripheral Atherectomy with Reference to Histology, Histochemistry, and Ultrastructure

Abstract

One hundred patients with symptomatic peripheral vascular disease were treated with a directional atherectomy catheter; 153 lesions comprising 98 stenoses and 55 occlusions were located in the iliac (n = 22), superficial femoral (n = 114), popliteal (n = 16), and anterior tibial (n = 1) arteries. The majority of these patients were poor candidates for balloon angioplasty because of the complexity of lesions. There were 70 eccentric and 28 concentric lesions and 55 occlusions (mean length 4.2 +/- 2.9 cm). Acute success rate was 94% for both stenoses and occlusions. Four patients were treated in both lower extremities. The stenoses were reduced from 85 +/- 12% to 12 +/- 10% acutely (occlusions 100% to 9 +/- 9%). Six-month angiographic follow-ups were performed in 81% of treated patients, the others refusing angiography. Mean stenosis after six months was 33 +/- 25% (occlusions 44 +/- 28%). Restenosis (> 50%) was found in 20% of treated lesions: 26% in concentric lesions, 8% in eccentric lesions, and 32% in occluded vessels. Treatment of peripheral vascular disease with the atherectomy device is safe and effective therapy with good long-term results. These results were obtained in complex lesions with 55 occlusions. Atherectomy seems to be particularly beneficial in the treatment of eccentric and complex stenoses and is not limited by occlusion or calcification. Furthermore, insight into the pathogenesis of arteriosclerosis and the development of restenosis is enabled by analysis of removed plaque material.

Infrainguinal Arterial Intervention: Is There a Role for an Atherectomy Device?

“…Other authors have also used the material retrieved from atherectomy for histologic analysis with the same hypothesis that lesion analysis can provide insight into the underlying disease process. 28 Additional studies in the coronary circulation suggest that optimal stent implantation is more easily achieved after plaque excision compared with angioplasty. 29 Additional devices, such as the Bard Rotary Atherectomy System (BRAS) (CR Bard, Murray Hill, NJ), the rotoblator Boston Scientific, Natick, MA) and the Xtrak device (Xtrak Medical Inc, Salem, NH), have also been evaluated in the periphery, have shown poor results, have been met with limited clinical enthusiasm, and have no significant current clinical use.…”

“…Other authors have also used the material retrieved from atherectomy for histologic analysis with the same hypothesis that lesion analysis can provide insight into the underlying disease process. 28 Additional studies in the coronary circulation suggest that optimal stent implantation is more easily achieved after plaque excision compared with angioplasty. 29…”