Acute and long-term outcome of silverhawk assisted atherectomy for femoro-popliteal lesions according the TASC II classification: a single-center experience

作者：Sixt S^*; Rastan A; Beschorner U; Noory E; Schwarzwaelder U; Buergelin K; Schwarz T; Mueller C; Hauk M; Brantner R; Moehrle C; Linnemann B; Macharzina R; Neumann F J; Zeller T

来源：VASA-Journal of Vascular Diseases, 2010, 39(3): 229-236.

DOI：10.1024/0301-1526/a000034

• Atherectomy
• silverhawk
• femoropopliteal lesions
• TASC II classification

Background: Directional atherectomy (DA) has become popular in some centers to remove atherosclerotic plaques in femoro-popliteal lesions. Although immediate and also short - term outcome data are promising, solid long-term data are warranted to justify the widespread use in daily practice.
Patients and methods: In this prospective study de novo and restenotic lesions of the femoro-popliteal segments were treated with the Silverhawk (TM) device. 161 consecutive patients (164 lesions) with peripheral artery disease (PAD) Rutherford classes 2 to 5 were included from June 2002 to October 2004 and October 2006 to June 2007 (59% male, mean age 67 +/- 11 years, range 40 to 88) and the outcome analyzed according to the TASC II classification.
Results: DA alone was performed successfully in 28% (n = 46), adjunctive balloon angioplasty in 65% (n = 107) and stenting in 7% (n = 11). The overall technical success rate was 76% (124/164) and the procedural success rate 95% (154/164). At 12 months primary patency rate was 61% (85/140) and the secondary patency rate was 75% (105/140) in the entire cohort, being less favourable in TASC D compared to TASC A to C lesions (p = 0.034 and p<0.001, respectively). Furthermore the restenosis rate differed trendwise (p = 0.06) between de novo and restenotic lesions. Changes in the ABI and the Rutherford classes were significantly in favour of TASC A to C lesions compared to TASC D after 12 months (p = 0.004). The event free survival (MI, TIA, or restenosis) was 48% at 12 months and 38.5% at 24 months. Predictor for restenosis in the multivariable analysis was only male gender (p=0.04).
Conclusions: The results in TASC D lesions are inferior to those in the lesser stages. DA of femoro-popliteal arteries leads shows a trend to better long-term technical and clinical outcome in de novo lesions compared to restenotic lesions.

• 出版日期2010-8