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Park JH, Lee SS. Management of Pseudoaneurysm as a Delayed Complication after Using Rotational Atherectomy in Popliteal Artery Atherosclerosis: A Case Report. Vasc Specialist Int 2024; 40:23. [PMID: 38918946 PMCID: PMC11199937 DOI: 10.5758/vsi.240046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
Although intravascular atherectomy is widely used for debulking calcified atheromas in peripheral arterial disease, it is associated with complications. Delayed rupture with pseudoaneurysm formation is rare. We report the case of a 73-year-old man who developed a 24 mm×20 mm×27 mm popliteal artery (PA) pseudoaneurysm after rotational atherectomy. Initially, the patient presented with intermittent claudication. Preoperative computed tomographic angiography (CTA) showed a severely calcified atheroma in the PA. Rotational atherectomy was performed using the Jetstream™ device (Boston Scientific). Postoperatively, the ankle-brachial index and symptoms improved. However, 6 days after the atherectomy, the patient complained of calf pain and swelling. Follow-up CTA revealed a pseudoaneurysm and hematoma in the popliteal fossa. Open conversion with removal of the heavily calcified plaque and patch angioplasty were performed via the posterior approach. Delayed PA rupture and pseudoaneurysm formation after rotational atherectomy are rare; however, they require prompt management.
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Affiliation(s)
- Je Hyung Park
- Division of Vascular and Endovascular Surgery, Department of Surgery, BongSeng Memorial Hospital, Busan, Korea
| | - Sang Su Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea
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Yazu Y, Fujihara M, Tsukizawa T, Kozasa T, Yokoi Y. Optical Frequency Domain Imaging to Quantify the Amount of Calcification in Femoropopliteal Artery Lesions Treated with Atherectomy Devices. Cardiovasc Intervent Radiol 2024; 47:685-687. [PMID: 38565716 DOI: 10.1007/s00270-024-03719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Yuko Yazu
- Department of Clinical Engineering, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan.
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Higashi-ku, Fukuoka, Japan.
| | - Tomofumi Tsukizawa
- Department of Clinical Engineering, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Tasuku Kozasa
- Department of Clinical Engineering, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
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Mori S, Yamawaki M, Fukagawa T, Yamaguchi K, Mizusawa M, Shirai S, Honda Y, Tsutsumi M, Kobayashi N, Ito Y. Impact of "black rock" on clinical outcomes after endovascular therapy for de novo calcified femoropopliteal lesions. Heart Vessels 2023; 38:1356-1363. [PMID: 37369857 DOI: 10.1007/s00380-023-02284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 06/29/2023]
Abstract
The relationship between severity of calcification and clinical outcomes after endovascular therapy (EVT) for femoropopliteal lesions is well known. We often encounter dense calcifications in our daily practice, which are darker than normal calcifications on angiography. Accordingly, we named it "black rock" (BR), and investigated its impact on clinical outcomes after EVT. We retrospectively analyzed 677 lesions in 495 patients who underwent EVT for de novo calcified femoropopliteal lesions at our hospital between April 2007 and June 2020. BR is defined as a calcification which is 1 cm or more in length, occupies more than half of the vessel diameter, and appears darker than the body of the femur on angiography. Propensity score matching analysis was performed to compare clinical outcomes between lesions with BR [BR (+) group] and without BR [BR (-) group]. A total of 119 matched pairs of lesions were analyzed. Primary patency at 2 years was significantly lower in the BR (+) group than in the BR (-) group (48% vs. 75%, p = .0007). Multivariate analysis revealed that the presence of BR [hazard ratio (HR) = 2.23, 95% confidence interval (CI); 1.48-3.38, p = .0001], lesion length (HR = 1.03, 95%CI; 1.00-1.06, p = .0244), and no scaffold use (HR = 1.58, 95%CI; 1.06-2.36, p = .0246) were predictors of restenosis. The presence of BR is independently associated with clinical outcomes after EVT for de novo calcified femoropopliteal lesions.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan.
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Tomoya Fukagawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Kohei Yamaguchi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Masafumi Mizusawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan
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Fujihara M, Takahara M, Iida O, Kawasaki D, Soga Y, Tobita K, Horie K, Takagi T, Okamoto S, Nakama T, Sasaki S, Tsubakimoto Y, Suematsu N. Endovascular Therapy with Interwoven Nitinol Stent Placement after Predilation for Heavily Calcified Femoropopliteal Artery Disease: Results of the BURDOCK Study. J Vasc Interv Radiol 2023; 34:1929-1937. [PMID: 37527768 DOI: 10.1016/j.jvir.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To investigate the 1-year and 2-year clinical outcomes of interwoven stent (IWS) implantation for symptomatic femoropopliteal arterial disease with calcification. MATERIAL AND METHODS This prospective multicenter study evaluated 308 limbs (63% with the peripheral arterial calcium scoring system 3 and 4 severe calcification and 87% with ≥180° calcification on intravascular ultrasound) of 299 patients (diabetes in 66.9%, chronic renal failure in 52.8%, and dialysis in 49.2%) who underwent IWS (Supera; Abbott, Abbott Park, Illinois) implantation after sufficient predilation (residual stenosis < 30%) for calcified femoropopliteal lesions. The primary outcome measure was primary patency (freedom from restenosis) at 1 and 2 years, whereas the secondary outcome measure included freedom from clinically driven target lesion revascularization (CD-TLR). Clinical parameters associated with loss of patency were explored. RESULTS Kaplan-Meier analysis showed that primary patency was 88.2% (95% confidence interval [CI], 84.5%-92.1%) at 1 year and 80.8% (95% CI, 76.1%-85.8%) at 2 years. The CD-TLR-free rate was 96.5% and 94.8% at 1 and 2 years, respectively. The characteristics associated with loss of patency were restenotic lesion with and without stent implantation (adjusted hazard ratio, 1.96 and 2.40; P = .047 and .041, respectively), chronic total occlusion (adjusted hazard ratio, 1.88; P = .022), and popliteal involvement (adjusted hazard ratio, 2.60; P = .002). CONCLUSIONS The implantation of IWS after sufficient predilation for calcified femoropopliteal atherosclerotic disease demonstrated clinically acceptable primary patency.
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Affiliation(s)
- Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan; Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Morinomiya Hospital, Osaka, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazunori Horie
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Tomonari Takagi
- Cardiovascular Center, Takatsu General Hospital, Kanagawa, Japan
| | - Shin Okamoto
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Chiba, Japan
| | - Shinya Sasaki
- Department of Cardiology, Saka General Hospital, Miyagi, Japan
| | | | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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Teßarek J, Elger F, Kolvenbach R, Liebetrau D. [Atherectomy with a Novel Device Offering Wider Options]. Zentralbl Chir 2023; 148:429-437. [PMID: 37699429 DOI: 10.1055/a-2156-5891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Catheter-based atherectomy has been discussed for some years, although the conclusions have been controversial. Recent study data did show the feasibility of multifunctional atherectomy devices for complex lesion morphologies, with moderate material use. This is then thus an alternative to bypass surgery, although a direct comparison is lacking.The results of the ByCross approval study were compared to technical and clinical data from various atherectomy systems in terms of range of indication, limitations as defined by the manufacturer, the success and complication rate and the instructions for use. As in many recent studies, a residual stenosis ≤ 50% after atherectomy and ≤ 30% in the completion imaging was defined as the primary endpoint and proof of technical success.Lesions recruited for the ByCross study were more complex than in other studies, with respect to the lesion length (124.7 mm vs. 34 mm in the EASE study and 67.2 mm in the VISION study) and the degree of stenosis (99.4% vs. 88.5% in the EASE and 78,7% in the VISION study). Calcification was also more severe - as defined by the PACSS (Peripheral Artery Calcification Severity Score). ByCross allowed recanalisation of lesions without wire passage prior to atherectomy (26.82%), which is a must for all other systems. The variable tip diameter of the ByCross can achieve a lumen gain of 4.7 mm without tip or wire exchange or run time limits. The 0% rate of embolic events, which is unique for atherectomy device approval studies, can be explained by the working principle and the high aspiration rate. No vessel injuries occurred, and the 6-month follow-up results showed 0% revascularisation rate.New generation atherectomy systems offer safe and effective enlargement of the endovascular portfolio. The ByCross device is an atherectomy, thrombectomy and crossing device free from investment and has a wider range of indications for the iliac and the femorodistal segments, which supports ByCross atherectomy as an alternative for bypass surgery.
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Affiliation(s)
- Jörg Teßarek
- Gefäßchirurgie, Bonifatius-Hospital, Lingen, Deutschland
| | - Florian Elger
- Gefäßchirurgie, Universitätsklinikum Göttingen, Gottingen, Deutschland
| | - Ralf Kolvenbach
- Gefäßchirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Deutschland
| | - Dominik Liebetrau
- Gefäßchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
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Min A, Alkhalifa F, Ahrari A, Healy G, Jaberi A, Tan KT, Mafeld S. Insights From the FDA's MAUDE Database Regarding the Real-World Safety of Jetstream Atherectomy for Peripheral Arterial Disease. J Endovasc Ther 2023:15266028231202718. [PMID: 37750495 DOI: 10.1177/15266028231202718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Rotational atherectomy has shown promise as an adjunctive therapy to percutaneous transluminal angioplasty (PTA) and stenting for the treatment of peripheral arterial disease (PAD). However, published data regarding the safety of these devices are limited. The Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database collects reports of adverse event for medical devices. We present 3 years of MAUDE adverse events data for the Jetstream Atherectomy System (Boston Scientific) for the treatment of PAD. MATERIALS AND METHODS We searched MAUDE from January 1, 2019 to December 31, 2021. Duplicate reports and those with insufficient information were excluded, leaving a total of 500 reports for analysis. Adverse events were categorized as either patient complication, device malfunction, or both. Adverse events were classified using the Cardiovascular and Interventional Radiological Society of Europe's (CIRSE) classification system for adverse events. RESULTS The most common patient complications were embolism (22; 4.4%), dissection (17; 3.4%), vessel perforation (12; 2.4%), and device fracture in the patient (6; 1.2%). The most common modes of device failure were entrapment of the device on the guidewire (134; 27%), loss of blade rotation (116; 23%), loss of aspiration (99; 20%), and mechanical damage (57; 11%). As per the CIRSE adverse events classification, most events had no post-procedural sequelae (475; 95%), followed by those requiring prolonged observation (14; 2.8%), and post-procedural therapy without long-term sequelae (10; 2.0%). One hundred six devices (21%) were returned for manufacturer analysis. CONCLUSION We highlight important adverse events encountered in real-world practice with the Jetstream Atherectomy System. This analysis provides further understanding of the safety profile and modes of failure of Jetstream, and could help guide improvements in product design and manufacturer-user training. There is greater need for root-cause analysis that can aided by returning devices to the manufacturer. CLINICAL IMPACT We highlight important adverse events encountered in real-world practice with the Jetstream Atherectomy System. The MAUDE database is useful for capturing and characterizing modes of device failure/malfunction not typically described in conventional clinical studies. This may provide valuable information to help guide improvements in product design and manufacturer-user training. This information could also potentially be useful in helping establish manufacturer and product liability in the setting of medicolegal claims. We hope that by contributing to the growing understanding of the safety profile of the Jetstream Atherectomy System, our study may help physicians and patients come to more informed decisions regarding treatment options for PAD.
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Affiliation(s)
- Adam Min
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Fahd Alkhalifa
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Aida Ahrari
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Gerard Healy
- Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Arash Jaberi
- Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Kong Teng Tan
- Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sebastian Mafeld
- Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Tokuda T, Hirano K, Takemura A, Oba Y. 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. Health Sci Rep 2023; 6:e1586. [PMID: 37752975 PMCID: PMC10519130 DOI: 10.1002/hsr2.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/15/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
Background and Aims In 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. Methods This 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. Results A 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. Conclusions The 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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Affiliation(s)
| | - Keisuke Hirano
- Department of CardiologyToyohashi Heart CenterToyohashiJapan
| | | | - Yasuhiro Oba
- Department of CardiologyNagoya Heart CenterNagoyaJapan
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Haraguchi T, Tsujimoto M, Otake R, Kashima Y, Sato K, Fujita T. Propensity score-matched analysis of six-month outcomes of paclitaxel-coated balloons combined with UltraScore balloons versus conventional scoring balloons for femoropopliteal lesions. Diagn Interv Radiol 2023; 29:535-541. [PMID: 37067068 PMCID: PMC10679619 DOI: 10.4274/dir.2023.232114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Combination angioplasty with paclitaxel-coated balloons (PCBs) and conventional scoring balloons for femoropopliteal lesions has demonstrated satisfactory results, even for complex lesions. The UltraScore balloon (Becton Dickinson, New Jersey, USA), which has a maximum length of 300 mm, has two longitudinal 0.010-inch stainless steel wires and is a new treatment option for complex femoropopliteal lesions. However, no studies have evaluated the effect of the UltraScore balloon on femoropopliteal lesions. This study aimed to compare the clinical efficacy of angioplasty over a six-month period using UltraScore balloons versus conventional scoring balloons for the treatment of atherosclerotic femoropopliteal lesions with PCBs. METHODS A retrospective single-center observational study enrolled 272 patients who underwent PCB angioplasty combined with an UltraScore balloon (n = 58) or conventional scoring balloon (n = 214) without bailout stenting. Propensity score matching was used to minimize intergroup differences in baseline characteristics, and six-month outcomes were compared between the two groups. The primary endpoint was a technical success (i.e., residual angiographic stenosis of <30% with non-severe dissection). The secondary endpoints were the incidences of periprocedural complications, restenosis, and target lesion revascularization (TLR). RESULTS After propensity score matching, 50 matched pairs of patients were selected for analysis. The UltraScore group had a significantly longer vessel length (192.8 ± 94.9 versus 36.6 ± 7.9 mm, P < 0.001), a lower frequency of non-compliant balloon (26.0% versus 56.0%, P = 0.002), and a smaller PCB diameter (5.32 ± 0.65 versus 5.66 ± 0.52 mm, P = 0.002) compared with the scoring group. The primary endpoint of technical success was significantly higher in the UltraScore group than in the scoring group (76.0% versus 56.0%, P = 0.035). There were no significant differences in periprocedural complications (4.0% versus 2.0%, P = 0.562), six-month restenosis (4.0% versus 8.0%, P = 0.339), and TLR (2.0% versus 4.0%, P = 0.500) between both groups. The multivariate logistic regression analysis showed that UltraScore use was independently associated with an increase in technical success (odds ratio: 2.58; 95% confidence interval: 1.05-6.36, P = 0.040). CONCLUSION The use of an UltraScore balloon during PCB angioplasty for femoropopliteal lesions significantly improved technical success compared with conventional scoring balloons. UltraScore use was an independent predictor of technical success, indicating its potential advantages in peripheral intervention procedures.
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Affiliation(s)
- Takuya Haraguchi
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Masanaga Tsujimoto
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Ryo Otake
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yoshifumi Kashima
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Katsuhiko Sato
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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Mori S, Takahara M, Nakama T, Tobita K, Hayakawa N, Iwata Y, Horie K, Suzuki K, Yamawaki M, Ito Y. Impact of calcification on clinical outcomes after drug-coated balloon angioplasty for superficial femoral artery disease: Assessment using the peripheral artery calcification scoring system. Catheter Cardiovasc Interv 2023; 101:892-899. [PMID: 36883957 DOI: 10.1002/ccd.30622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To investigate whether the severity of calcification assessed by the peripheral artery calcification scoring system (PACSS) was associated with clinical outcomes of drug-coated balloon (DCB) angioplasty for femoropopliteal lesions. MATERIALS AND METHODS We retrospectively analyzed 733 limbs with intermittent claudication of 626 patients, who underwent DCB angioplasty for de novo femoropopliteal lesions between January 2017 and February 2021 at seven cardiovascular centers in Japan. The patients were categorized using the PACSS classification (grades 0-4: no visible calcification of the target lesion, unilateral wall calcification < 5 cm, unilateral calcification ≥ 5 cm, bilateral wall calcification < 5 cm, and bilateral calcification ≥ 5 cm, respectively). The main outcome was primary patency at 1 year. The Cox proportional hazards analysis was used to explore whether the PACSS classification was an independent predictor of clinical outcomes. RESULTS The distribution of PACSS was grade 0 in 38%, grade 1 in 17%, grade 2 in 7%, grade 3 in 16%, and grade 4 in 23%. The 1-year primary patency rates in these grades, respectively, were 88.2%, 89.3%, 71.9%, 96.5%, and 82.6%, respectively (p < 0.001). Multivariate analysis disclosed that PACSS grade 4 (hazard ratio: 1.82, 95% confidence interval 1.15-2.87, p = 0.010) was associated with restenosis. CONCLUSION The PACSS grade 4 calcification was independently associated with poor clinical outcomes after DCB angioplasty for de novo femoropopliteal lesions.
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Affiliation(s)
- Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kishiwada, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Kishiwada, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kishiwada, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yo Iwata
- Department of Cardiology, Funabashi Municipal Medical Center, Kishiwada, Osaka, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Kishiwada, Osaka, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kishiwada, Osaka, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kishiwada, Osaka, Japan
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