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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ADVANCES IN BELOW-THE-KNEE MANAGEMENT
The Journal of Cardiovascular Surgery 2012 Aprile;53(2):177-86
Treatment of femoropopliteal stenoses and occlusions with mechanical rotational catheters: comparison of results with the Rotarex and Pathway devices
Wissgott C., Kamusella P., Andresen R. ✉
Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
AIM: For the treatment of chronic lesions, various ablative procedures have been developed with the aim of improving the outcome of percutaneous transluminal angioplasty (PTA)/stent and/or reducing the length and number of implanted stents by removing stenotic or occlusive material. The objective of this study was to compare two mechanical rotational catheters (Rotarex and Pathway) with regard to their safety and effectiveness in the treatment of stenoses and occlusions of the femoropopliteal arteries.
METHODS: A total of 156 patients with chronic stenoses or occlusions of the femoropopliteal vasculature were treated, 114 of them with the Rotarex catheter and 42 with the Pathway catheter. The pre-interventional Rutherford classification was on average 3.32 (2-5) in the Rotarex group and 2.93 (2-5) in the Pathway group. The mean lesion length was 13.9 cm (2-30 cm) and 5.1 cm (1-10 cm), respectively (P<0.05). The Ankle-Brachial Index (ABI) was determined pre- and postinterventionally and after 12 months. Colour-coded duplex ultrasound was additionally performed as a follow-up.
RESULTS:The technical success rate was 98.2 % in the Rotarex group and 97.6% in the Pathway group. In the Rotarex group, additional balloon dilatation was performed in 75 patients (65.8%) and stent implantation was necessary in 12 patients (10.5%). In the Pathway group, 27 patients (64.3%) underwent additional balloon dilatation and 5 (11.9%) stent implantation. Clinically, there was an increase in the ankle-brachial index from 0.59 to 0.84±0.15 postinterventionally and 0.80±0.16 12 months after Rotarex treatment, compared with an increase from 0.62±0.14 to 0.84±0.15 postinterventionally and 0.81±0.12 12 months after Pathway treatment. In addition, there was a reduction in the Rutherford stage to 1.73 (1-3) and 1.43 (1-3), respectively. During the follow-up period, 21 (21.4%) restenoses occurred in the Rotarex group and 8 (19.0%) in the Pathway group. Peri-interventional complications included 7 dissections (4 after Rotarex, 3 after Pathway). Two distal embolisations were observed (both after Pathway). Throughout the entire duration of the study there were no amputations or fatalities.
CONCLUSION:The atherectomy of lesions of the femoropopliteal arteries using the Rotarex and Pathway systems is safe. The low stent rate peri-interventionally and the low restenosis rate after 12 months, with a significantly longer lesion length, indicate a better effectiveness of the Rotarex system as a whole.