Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions

Abstract

Purpose To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes

“…Main data regarding the utility of MATH using the Rotarex S device in the management of acute and subacute lower limb occlusive disease and its potential contribution in prolonging the durability of endovascular revascularization are coming mainly from retrospective studies ( Table 1) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Looking at the literature, we identified 16 clinical studies, which evaluated MATH using the Rotarex S device as a primary treatment during revascularization interventions in patients with peripheral arterial occlusive disease in iliac, femoral, and/or popliteal arteries.…”

“…The majority were retrospective cohorts with a total number of 1,844 patients having had Rotarex S MATH as part of their treatment. Out of 16 studies, 8 studies investigated the role of Rotarex S MATH for native vessel occlusion (12)(13)(14)(15)(16)(17)(18)(19), 3 studies used Rotarex S MATH for in-stent restenosis/occlusion (6, 20, 21), 2 studies tested Rotarex S MATH for bypass thrombosis (1,10), and 3 studies evaluated Rotarex S MATH for mixed populations combining the three previous indications (11,22,23).…”

“…Eight retrospective studies reported results regarding the role of Rotarex S MATH in peripheral acute occlusive disease in native vessels, investigating a total number of 1,095 patients (12)(13)(14)(15)(16)(17)(18)(19). The largest study was reported by Freitas et al, investigating 525 consecutive patients with a mean age of 66.7 ± 10.7 years (14).…”

“…Therefore, fast diagnosis and effective reperfusion strategy are important measures for the patient. In these cases, percutaneous rotational MATH using the Rotarex S device is an effective and safe endovascular therapeutic alternative to the established lysis or surgical therapy (6,9,(12)(13)(14)(15)(26)(27)(28)(29). Rotarex S MATH is useful as a vessel preparation tool with the rationale that efficacy depends on the presence of fragmentable and removable occlusive material.…”

Acute Limb Ischemia Therapies: When and How to Treat Endovascularly

“…4,9,12 In addition to catheter-directed thrombolysis, endovascular thrombectomy may serve as a complimentary or standalone technique for percutaneous revascularization that ideally speeds revascularization and limits the need for thrombolysis. [19][20][21][22][23][24][25] Endovascular thrombectomy has seen rapid innovation and increase in the number of devices available over the past decades. The devices are often categorized into four groups: mechanical aspiration, rheolytic, ultrasonic, or combination.…”