Outcomes of rotational atherectomy in complex lesions of the superficial femoral artery

Ponukumati, Aravind S.; Suckow, Bjoern D.; Powell, C.J.; Stone, David H.; Zwolak, Robert M.; Goodney, Philip P.; Zacharias, Nikolaos; Powell, Richard J.

doi:10.1016/j.jvs.2020.03.040

Cited by 10 publications

(2 citation statements)

References 10 publications

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“…Various devices have been developed to overcome severely calcified lesions. Rotational or Jetstream atherectomy for the femoropopliteal artery showed a sustained patency rate with a drug‐coated balloon strategy 11,12 . However, these atherectomy devices require dedicated guidewires, and as a premise, it is necessary to pass severely calcified lesions with a conventional microcatheter.…”

Section: Discussionmentioning

confidence: 99%

Utility and safety of a novel method using a Wingman catheter for patients with lower extremity arterial disease complicated with severely calcified lesions: Wingman's bevel tip inner catheter removal technique—A prospective cohort study

Tokuda,

Hirano,

Takemura

et al. 2023

Health Science Reports

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Background and AimsIn cases of lower extremity artery disease (LEAD) accompanied by heavily calcified lesions, endovascular treatment becomes necessary at times. To effectively address these challenging calcified lesions, we developed an innovative approach named WINNER (Wingman's bevel tip inner catheter removal) technique. This study investigated the effectiveness and safety of a novel method using the WINNER technique.MethodsThis was a two‐center, prospective observational study. We analyzed the clinical data of patients with LEAD complicated with severely calcified lesions who underwent the WINNER technique between January 2021 and December 2022. We investigated the patients' characteristics, target lesions, and intervention results in terms of crossing device rates and periprocedural complications.ResultsA total of 35 patients were treated using the WINNER technique for LEAD complicated by severely calcified lesions. Key patient characteristics were a mean age of 75 ± 9 years, 83% male, 71% hemodialysis, 60% chronic limb‐threatening ischemia, and mean lesion length of 147 ± 88 mm. Using the WINNER technique, a device crossing was achieved in 34 patients (97.1%). Wire perforation occurred in one patient, and WINNER catheter rupture occurred in three patients.ConclusionsThe WINNER technique is useful for treating severely calcified lesions, and we should consider using this technique to cross devices for lesions with severe calcifications.

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Section: Discussionmentioning

confidence: 99%

Utility and safety of a novel method using a Wingman catheter for patients with lower extremity arterial disease complicated with severely calcified lesions: Wingman's bevel tip inner catheter removal technique—A prospective cohort study

Tokuda,

Hirano,

Takemura

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

show abstract

“…The Multicentric National Registry trial on the use of rotational atherectomy in femoral–popliteal occlusive atherosclerotic disease (MORPHEAS) is the first study to compare results from four individual vascular centres which demonstrated reproducible between-hospital outcomes regarding the use of rotational atherectomy with the Jetstream Atherectomy device XC (Pathway Medical Technologies, Inc., Redmond, WA, USA) for the treatment of femoropopliteal occlusive disease [ 3 ]. At 12 months’ follow-up, freedom from target lesion revascularisation in complex lesions of the superficial femoral artery (SFA) and infrainguinal arterial disease appears to be between 80 and 90% in different studies [ 4 , 5 , 6 ]. Teneva et.…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Analysis of Mid-Term Outcomes of Atherectomy-Assisted Endovascular Treatment in Severe Peripheral Arterial Disease

Avranas,

Pitoulias,

Taneva

et al. 2024

JCM

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Background: Endovascular treatment of lower-extremity peripheral disease (PAD) is associated with higher complication rates and suboptimal outcomes in women. Atherectomy has shown favourable outcomes in calcified lesions, minimising the incidence of stent placement caused by recoil or flow-limiting dissection. To date, there are no published mid-term outcomes evaluating the performance of atherectomy differentiated by sex. This study aims to evaluate sex-specific outcomes and prognostic factors affecting the results of atherectomy-assisted endovascular treatment in severe PAD. Methods: A retrospective analysis was conducted at a single centre in Germany, initiated by physicians and not sponsored by industry, on patients presenting with Rutherford categories ranging from III to V and featuring de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries. The intervention involved rotational atherectomy-assisted angioplasty utilising the Jetstream (Boston, US®) device. The point of interest of this study was postinterventional clinical improvement as well as mid-term outcomes, including primary patency, over a targeted 2-year follow-up period. Statistical analysis utilised Cox regression (survival analysis) to calculate hazard ratios according to sex category. Comparative survival analysis was performed using the log-rank test and visually represented through Kaplan–Meier curves. Risk factors associated with absence of clinical improvement were examined across both sex groups utilising the chi-square or Fisher exact test, as appropriate. Results: A total of 98 patients (103 limbs) were initially included, with >75% having moderate-to-severe lesion calcification (>50%). A total of 84 patients (97 limbs, 62 male and 35 female) proceeded to a 2-year follow-up (mean 16.4 months for males and 16.1 for females) after a successful index procedure. Age distribution, Rutherford class, diabetes, chronic kidney disease (CKD), target vessel, lesion type, and length were balanced among both groups. Similar primary patency rates, of 89% among female and 91% among male limbs, were observed (p = 0.471). Female patients exhibited a lower rate of clinical improvement based on the Rutherford scale in comparison to males (80.6% vs. 94.5%, p = 0.048). CDK was the only significant prognostic factor across pooled data (odds ratio for CKD: 15.15, p < 0.001). Conclusions: Rotational atherectomy showed comparably high rates of mid-term primary patency, with low rates of bailout stent placement. These findings highlight the beneficial use of atherectomy in female patients who are per se at risk for higher rates of complications during and after endovascular interventions.

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Indications for a “Surgery-First” Approach for the Treatment of Lower Extremity Arterial Disease

Kumar¹,

Long

Rimar³

et al. 2023

Annals of Vascular Surgery

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Outcomes of rotational atherectomy in complex lesions of the superficial femoral artery

Cited by 10 publications

References 10 publications

Utility and safety of a novel method using a Wingman catheter for patients with lower extremity arterial disease complicated with severely calcified lesions: Wingman's bevel tip inner catheter removal technique—A prospective cohort study

Utility and safety of a novel method using a Wingman catheter for patients with lower extremity arterial disease complicated with severely calcified lesions: Wingman's bevel tip inner catheter removal technique—A prospective cohort study

Sex-Specific Analysis of Mid-Term Outcomes of Atherectomy-Assisted Endovascular Treatment in Severe Peripheral Arterial Disease

Indications for a “Surgery-First” Approach for the Treatment of Lower Extremity Arterial Disease

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