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Long-term results after directional atherectomy of femoro-popliteal lesions.

Abstract：

OBJECTIVES:Our objective in this research was the evaluation of the long-term results after directional atherectomy using the Silverhawk device (FoxHollow Technologies, Redwood City, California) of femoro-popliteal lesions. BACKGROUND:Considering reports on stent fractures in femoro-popliteal arteries, atherectomy may be a valuable alternative to stenting. METHODS:Eighty-four patients with 100 legs and 131 lesions with peripheral occlusive disease Rutherford categories 2 to 5 were included in a prospective registry. Forty-five lesions were de novo lesions (group 1; 34%), 43 lesions native vessel restenoses (group 2; 33%), and 43 lesions in-stent restenoses (group 3; 33%). Additional low pressure balloon angioplasty was used in 78 of 131 lesions (59%) and stenting in 8 lesions (6%). RESULTS:Technical success rate was 86% for atherectomy only and 100% after additional therapy. Mean lesion length was 43 +/- 54 mm, 105 +/- 122 mm, and 131 +/- 111 mm for group 1, group 2, and group 3, respectively (p < 0.001). Primary patency, defined as freedom of a >50% restenosis detected by duplex, was 84%, 54%, and 54% at 12 months (p = 0.002) and 73%, 42%, and 49%, at 18 months (p = 0.008); secondary patency rates were 100%, 93%, and 91% at 12 months (p = NS) and 89%, 67%, and 79% at 18 months (p = 0.001), respectively; and target lesion revascularization rate was 16%, 44%, and 47% at 12 months and 22%, 56%, and 49% at 18 months (p = 0.003 each) for group 1, group 2, and group 3, respectively. The only independent predictor for restenosis was treatment of restenotic lesions. Ankle-brachial index was significantly improved after 12 months and 18 months in all groups. CONCLUSIONS:Long-term technical and clinical results after directional atherectomy of femoro-popliteal lesions are in favor of de novo lesions compared with restenotic lesions.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Zeller T,Rastan A,Sixt S,Schwarzwälder U,Schwarz T,Frank U,Bürgelin K,Müller C,Rothenpieler U,Flügel PC,Tepe G,Neumann FJ

doi

10.1016/j.jacc.2006.07.031

subject

Has Abstract

pub_date

2006-10-17 00:00:00

pages

1573-8

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(06)01956-5

journal_volume

pub_type

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Long-term results after directional atherectomy of femoro-popliteal lesions.