Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system

Abstract

PurposeDirectional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure.MethodsPatients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG.ResultsMedian follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%–42%) at the end of DA, 40% (range, 30%–55%) at 1 month, 55% (range, 35%–85%) at 6 months, and 64% (range, 60%–100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months.ConclusionOur results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.

Short‐term efficacy and safety of TurboHawk atherectomy for in‐stent restenosis in peripheral artery disease: a single‐centre experience

“…In addition, the American Consensus on Endovascular Treatment of Femoral Artery Disease in 2014 19 pointed out that the use of an embolic protector during resection can reduce the embolic event. However, some scholars have advocated its use only when there is a calcification in the lesion 20 . When distal arterial embolization occurs, suction the plaque or dilate the balloon to promote plaque adherence and restore the lumen diameter.…”

“…However, some scholars have advocated its use only when there is a calcification in the lesion. 20 When distal arterial embolization occurs, suction the plaque or dilate the balloon to promote plaque adherence and restore the lumen diameter. Minko et al 21 studied 53 patients with superficial calcification stenosis (total of 59 lesions) treated with the Hawk system and reported that 7 (1.19%) had distal arterial embolization during surgery which were successfully removed by catheter suction.…”

Better treatment option in chronic superficial femoral artery occlusive disease: comparison of methods (meta-analysis)

“…When the TurboHawk catheter is used in the case of hard, complex calcified lesions, it should be accompanied by the SpiderFX™ Embolic Protection Device to eliminate the distal embolization risk. 2…”