Evaluation of the Pullback Atherectomy Catheter in the treatment of lower limb vascular disease

[Percutaneous mechanical atherectomy for treatment of peripheral arterial occlusive disease]

Peripheral arterial occlusive disease (PAOD) is still an extremely important politico-economic disease. Diverse treatment procedures exist but the pillars of therapy are changes in lifestyle, such as nicotine abstinence and walking exercise as well as drug therapy. Further therapy options are considered after conventional procedures have been exhausted. These further options consist of improvement of the blood supply by surgical or minimally invasive procedures. The latter therapy options include balloon dilatation and stenting as the most widely used techniques. More recent techniques also used are cryoplasty, laser angioplasty, drug-coated stents or balloons as well as brachytherapy or atherectomy, whereby this list makes no claims to completeness. The multitude of different treatment methods emphatically underlines the fact that no resounding success can be achieved with one single method. The long-term results of both balloon dilatation and stenting techniques show a need for improvement, which elicited the search for additional methods for the treatment of PAOD. Atherectomy represents such an alternative method for treatment of PAOD. Basically, the term atherectomy means the removal of atheroma tissue. For percutaneous atherectomy, in contrast to surgical procedures, it is not necessary to create surgically access to the vessel but accomplishes the atherectomy by means of dedicated systems via a minimally invasive access. There are two basic forms of mechanical atherectomy: directional and rotational systems.

Markedly eccentric peripheral vascular stenoses: percutaneous atherectomy with an endomyocardial biopsy device

In 23 patients, percutaneous atherectomy was performed with an endomyocardial biopsy device in 27 eccentric stenoses of lower limb arteries. The mean percentage stenosis was reduced from 82% to 14% (P: <.001). Histopathologic examination revealed no media or adventitial tissue in the extracted particles. The technical success and complication rates were similar to those reported for conventional percutaneous transluminal angioplasty of short symmetric lesions.

Peripheral atherectomy with the Pullback Atherectomy Catheter: procedural safety and efficacy in a multicenter trial. PAC Investigators

PURPOSE

To report the initial results of a newly designed catheter for percutaneous circumferential atherectomy in patients with lower extremity atherosclerotic occlusive disease.

METHODS

The Pullback Atherectomy Catheter (PAC) is an over-the-wire device that circumferentially debulks atherosclerotic lesions in peripheral arteries up to 6 mm in diameter. Pullback atherectomy with or without adjunctive balloon angioplasty was attempted in 190 patients (246 lesions) with lower extremity lesions < or = 7.0 cm in length and a diameter stenosis > 50%.

RESULTS

Angiographic success was accomplished in 95% (234/246) of the of the lesions attempted. The baseline ankle-brachial index rose from 0.61+/-0.20 to 0.83+/-0.20 (p < 0.001) at 24 hours after the procedure. There were no major complications (distal emboli, dissection, thrombosis, or perforation requiring surgical correction) attributable to pullback atherectomy.

CONCLUSIONS

The acute results of pullback atherectomy demonstrate an extremely high technical success rate and an excellent safety record for lower extremity percutaneous revascularization. The catheter facilitates debulking longer lesions, but it is limited to small-diameter (< or = 6 mm) peripheral vessels.

Peripheral Atherectomy with the Pullback Atherectomy Catheter: Procedural Safety and Efficacy in a Multicenter Trial

Purpose:

To report the initial results of a newly designed catheter for percutaneous circumferential atherectomy in patients with lower extremity atherosclerotic occlusive disease.

Methods:

The Pullback Atherectomy Catheter (PAC) is an over-the-wire device that circumferentially debulks atherosclerotic lesions in peripheral arteries up to 6 mm in diameter. Pullback atherectomy with or without adjunctive balloon angioplasty was attempted in 190 patients (246 lesions) with lower extremity lesions ≤ 7.0 cm in length and a diameter stenosis > 50%.

Results:

Angiographic success was accomplished in 95% (234/246) of the of the lesions attempted. The baseline ankle-brachial index rose from 0.61 ± 0.20 to 0.83 ± 0.20 (p < 0.001) at 24 hours after the procedure. There were no major complications (distal emboli, dissection, thrombosis, or perforation requiring surgical correction) attributable to pullback atherectomy.

Conclusions:

The acute results of pullback atherectomy demonstrate an extremely high technical success rate and an excellent safety record for lower extremity percutaneous revascularization. The catheter facilitates debulking longer lesions, but it is limited to small-diameter (≤ 6 mm) peripheral vessels.