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

Plaque Excision in Management of Lower Extremity Peripheral Arterial Disease with the SilverHawk Atherectomy Catheter

Atherectomy, the removal of plaque from diseased vessels, is theoretically appealing with respect to various procedures used for revascularization of lower extremity vessels. Instead of damaging the native vessel by pushing aside plaque with a balloon or stent, the plaque is removed. Many atherectomy devices have been designed in attempts to achieve this goal. The SilverHawk device is the latest percutaneous device employing this treatment strategy. We discuss patient selection, technical considerations, and strategies for both above and below the knee revascularization, as well as pitfalls in each location based on our experience with over 200 patients.

[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.

Native superficial femoral artery peripheral atherectomy site pseudoaneurysm: a case report

A 45-year-old woman who presented with blue toe syndrome was treated with atherectomy for a focal plaque located in the superficial femoral artery. She subsequently developed a large pseudoaneurysm at the atherectomy site requiring multiple sequential endovascular procedures in order to maintain in-line blood flow to the foot. Pseudoaneurysm formation at native peripheral artery atherectomy site has not been reported previously. We discuss possible complications of atherectomy and the possible mechanism of pseudoaneurysm formation after atherectomy. We address the importance of understanding risks of these minimally invasive procedures along with planning follow-up duplex and potential bail-out tactics.

Preliminary experience with the Xtrak debulking device in the treatment of peripheral occlusions

PURPOSE

To report our initial experience with a new rotary debulking device designed for treating long, diffusely diseased arterial segments.

METHODS

Ten symptomatic patients (8 men; mean age 63 years, range 34-76) with occluded superficial femoral (n = 6) or popliteal (n = 4) arteries were enrolled into a study to evaluate the debulking capabilities of a rotational atherectomy device. Occlusion length ranged from 4.0 to 16.1 cm (mean 11.1 +/- 4.10). The occlusions were treated with a low-speed, over-the-wire rotary device featuring a flexible, spiral "corkscrew" that embeds itself in the obstructive material while a rotary cutting catheter simultaneously cuts and captures the obstruction in a single pass.

RESULTS

The device cut and retrieved material in a single pass from all segments without device-related complications. The captured material consisted of a mixture of atherosclerotic plaque and thrombus. Minimum lumen diameters (MLD) increased from 0.0 to 2.2 +/- 1.09 mm (p<0.05) after Xtrak treatment and to 4.09 +/- 1.20 mm (p<0.05) after adjunctive balloon dilation, which was used in 8 of 10 segments. All patients improved clinically after the procedure, with an increased the mean ankle-brachial index sustained at 6 months (0.69 +/- 0.32, p<0.05 compared to baseline and 1-month measurements). Six months after the procedure, 7 patients remained free of clinical symptoms, while 3 patients required a subsequent intervention.

CONCLUSIONS

These initial results demonstrate that the Xtrak device can safely debulk long segments of diffusely diseased arteries in a single pass while simultaneously retrieving the occluding material. Supplementary angioplasty may be required in the majority of cases. Larger studies are required to determine whether debulking followed by balloon dilation improves the long-term prognosis in patients with chronic lower limb occlusions.