OCT evaluation of directional atherectomy compared to balloon angioplasty




Abstract


Directional atherectomy (DA) is one of the most commonly used modalities for the treatment of obstructive femoropopliteal peripheral arterial disease (PAD), especially in patients with large and calcified atherosclerotic plaques. The effect of directional atherectomy to the vascular wall compared to balloon angioplasty by optical coherence tomography (OCT) has not been previously described. We present the first case of OCT after directional atherectomy with SilverHawk followed by angiosculpt balloon angioplasty.


Highlights




  • •

    Directional atherectomy avoids the vascular mechanical damage caused by angioplasty balloons and the exposure of stent struts or the potential of stent fracture with stents.


  • •

    OCT can accurately assess the effect of endovacular interventions to the vessel wall.


  • •

    Although angiographic results after directional atherectomy are acceptable, OCT use demonstrated suboptimal improvement of the MLA requiring additional balloon angioplasty.


  • •

    Longer studies are needed to define whether the improved OCT results with angioplasty compared to DA may offer better clinical outcomes.



1


Introduction


Directional atherectomy (DA) is one of the most commonly used modalities for the treatment of obstructive femoropopliteal peripheral arterial disease (PAD), especially in patients with large and calcified atherosclerotic plaques. It offers the advantage of atherosclerotic debris aspiration combined with minimal arterial wall stretch injury which intuitively appears to be the preferred approach in such patients. However, clinical studies have not proven that directional atherectomy yields improved angiographic results, primary patency rates or clinical outcomes over balloon angioplasty or other transcatheter modalities (stenting, cryoballoon angioplasty, laser atherectomy) . The SilverHawk plaque excision system (Covidien, Plymouth, MN) is the most widely utilized directional atherectomy system in the United States. The effect of directional atherectomy to the vascular wall compared to balloon angioplasty by optical coherence tomography (OCT) has not been previously described.




2


Mini-review


A 68 year-old gentleman with right leg lifestyle limiting claudication and abnormal ankle–brachial index (ABI) was referred for invasive angiogram. A 5 French (F) sheath was placed in the left common femoral artery (CFA), and a selective right leg arteriogram was performed with the use of a 5 F internal mammary (IM) catheter. After the identification of a severe proximal superficial femoral artery (SFA) stenosis, a percutaneous intervention was decided ( Fig. 1 A ). The 5 F sheath was exchanged for a 7 F sheath which was advanced to the right CFA. After appropriate anticoagulation, the stenotic lesion was crossed with a 0.014 300 cm PT2 guidewire (Boston Scientific). A baseline OCT was performed with the Dragonfly OCT (St Jude Medical, Inc, St Paul, MN) catheter ( Fig. 2 A ).




Fig. 1


Invasive angiogram of the right SFA. A. Baseline: Serial 50–70% stenotic lesions visualized in the proximal and mid SFA. B,C: Directional atherectomy and post procedure results. Acceptable angiographic improvement of the stenosis to < 30% D–E: Angiosculpt angioplasty with post procedure results. Excellent angiographic improvement of the stenosis < 10%.



Fig. 2


OCT of the proximal and mid SFA. A: Baseline OCT (MLA: 5.35 mm 2 ). Mixed atherosclerotic plaque with minimal calcification. B–D: OCT after directional atherectomy (MLA: 9.30, 8.62 and 8.05 mm 2 ). Suboptimal improvement of the MLA. Absence of dissection, perforation or recoil. E–F: OCT after angiosculpt angioplasty (MLA: 21.26, 20.61 mm 2 ). Excellent results, without complications.

Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. Biodegradable polymer drug-eluting stents: ready for US prime time?
  2. The impact of precise robotic lesion length measurement on stent length selection: Ramifications for stent savings
  3. Transcatheter retrieval of device entrapment: management of a rare complication of percutaneous coronary intervention: Case report and literature review
  4. A rare complication: an attempt of retrieval of an aortic valve wrapped with pig tail catheter during transcatheter aortic valve implantation

Stay updated, free articles. Join our Telegram channel
Tags:
Nov 14, 2017 | Posted by in CARDIOLOGY | Comments Off on OCT evaluation of directional atherectomy compared to balloon angioplasty

Full access? Get Clinical Tree
Get Clinical Tree app for offline access