Percutaneous peripheral atherectomy: Angiographic and clinical follow-up of 60 patients

Abstract

The Simpson atherectomy catheter was used to treat 60 patients with a total of 94 lesions comprising 63 stenoses (mean length 1.1 +/- 0.5 cm) and 31 occlusions (4.2 +/- 2.9 cm) of the superficial femoral (n = 77), popliteal (n = 8), iliac (n = 8) and anterior tibial (n = 1) arteries. The immediate angiographic success rate was 90% for both occlusions and stenoses, and clinical success was obtained in 82% of patients. The stenoses were reduced from 83 +/- 13% to 17 +/- 18% acutely and to 31 +/- 26% at 6 months; the occlusions were reduced from 100% to 9 +/- 9% initially and to 60 +/- 34% at 6 months. Angiographic restenosis was found in 24% of lesions: 23% in concentric and 11% in eccentric lesions and 47% in total occlusions. At 1 year, 72% of patients had clinically patent arteries with maintained Doppler index and walking distance. Three of four patients undergoing repeat atherectomy had a second restenosis. In summary, the procedure was found to be safe and effective in the treatment of peripheral vascular disease. It appears to be particularly beneficial in the treatment of eccentric stenoses and is not limited by the presence of calcification.

Infrainguinal directional atherectomy: Long-term follow-up and comparison with percutaneous transluminal angioplasty

“…Major complications from the procedures are rare and almost all of the problems are related to the antegrade puncture site. Previous reports of DA for infrainguinal lesions are few, but have shown patencies of 72%-86% [7][8][9] at 1 year, and 83% [9] at 2 years. Our results are comparable at 1 year (86% assisted primary patency), but are lower at 2 years (64% assisted primary patency).…”

“…A substantial rate of restenosis after PTA, particularly for femoropopliteal recanalization [1][2][3], has led to the search for more effective percutaneous techniques [4][5][6]. One such technique, directional atherectomy (DA) with the Simpson peripheral atherectomy catheter, has been shown to have a high technical and initial clinical success rate [7][8][9]. This procedure was found to be effective in the treatment of iliac and infrainguinal lesions [7][8][9] as well as in venous bypass graft stenoses [9].…”

“…One such technique, directional atherectomy (DA) with the Simpson peripheral atherectomy catheter, has been shown to have a high technical and initial clinical success rate [7][8][9]. This procedure was found to be effective in the treatment of iliac and infrainguinal lesions [7][8][9] as well as in venous bypass graft stenoses [9]. A limited number of reports have also demonstrated acceptable long-term patency rates for DA [7,9], but improved long-term patency after DA compared with PTA has not been firmly established.…”

Percutaneous transluminal atherectomy of the superficial femoral and popliteal arteries: Long-term results in 48 patients

“…This finding indicates that although the atherectomy catheter is designed to remove eccentricities within the vessel (i.e., typically surface and subintimal atheromatous material), deeper cuts commonly occur into the medial wall of the vessel [13].…”

Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

“…Although the theoretical mechanism of DA is simple and the complication rate is low, little is known about the in vivo mechanism [5,6]. Effects ascribed to DA include ''ploughing'' caused by the stiff and relatively large device itself, ''dilatation'' caused by the one-sided low-pressure balloon, and ''shaving'' caused by the rotating cutter [7].…”