Atherectomy of heavily calcified femoropopliteal stenotic lesions

Abstract

Purpose: To investigate 1-year outcomes after atherectomy in patients with peripheral arterial disease (PAD) and heavily calcified stenotic lesions.

Materials and methods: Thirty-eight patients (mean age, 70 y ± 8; 24 men; TransAtlantic Inter-Society Consensus B-D disease; mean lesion length, 7.5 cm ± 3.5) with PAD (Rutherford score of 2-6) were included in this prospective study. In total, 42 calcified lesions of the superficial femoral artery (SFA) or popliteal artery were treated with the SilverHawk atherectomy device. Thirty-two lesions were located in the proximal or distal 3 cm of the SFA or in the popliteal artery, which were considered segments exposed to high biomechanical stress. Patients were followed up after 6 and 12 months. Clinical reevaluation included measurement of ankle-brachial index (ABI) and duplex sonography.

Results: The primary success rate of the procedure was 88%. In five cases, additional balloon angioplasty and/or stent implantation was necessary. Procedure-related embolization occurred in three cases and was treated by aspiration. The mean Rutherford score decreased significantly from 4.1 ± 1.0 to 1.0 ± 1.3 after 12 months. At the same time, the ABI increased significantly from 0.7 ± 0.3 to 0.9 ± 0.3. The primary patency rate was 69% after 1 year.

Conclusions: Atherectomy might be considered as an alternative approach in patients with PAD who have heavily calcified stenotic lesions, especially in areas with high biomechanical stress, where stent implantation is undesirable. Results after 1 year demonstrated a significant decrease of Rutherford score, an increase in ABI, and a reasonable patency rate.