Department of Diagnostic and Interventional Radiology, University Hospital Saarland Homburg, Kirrberger Strasse, 66421 Homburg/Saar, Saarland, Germany.
J Vasc Interv Radiol. 2011 Jul;22(7):995-1000. doi: 10.1016/j.jvir.2011.03.017. Epub 2011 May 18.
To investigate 1-year outcomes after atherectomy in patients with peripheral arterial disease (PAD) and heavily calcified stenotic lesions.
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.
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.
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.
研究经皮血管腔内斑块旋切术（atherectomy）治疗外周动脉疾病（PAD）伴严重钙化狭窄病变患者的 1 年随访结果。
本前瞻性研究共纳入 38 例 PAD 患者（平均年龄 70 岁±8 岁；24 例男性；跨大西洋介入学会共识分级 B-D 级；平均病变长度 7.5cm±3.5cm）。共 42 处股浅动脉（SFA）或腘动脉严重钙化病变采用 SilverHawk 斑块旋切系统进行治疗。32 处病变位于 SFA 近段或远段 3cm 内或腘动脉，这些部位被认为是承受高生物力学应力的节段。患者分别于术后 6 个月和 12 个月进行随访。临床评估包括踝肱指数（ABI）和双功超声检查。
该手术的主要成功率为 88%。5 例患者需进一步行球囊血管成形术和/或支架植入术。3 例患者发生与操作相关的栓塞，采用抽吸的方法进行治疗。术后 12 个月，患者的 Rutherford 评分从 4.1±1.0 显著降至 1.0±1.3，ABI 从 0.7±0.3 显著增至 0.9±0.3。术后 1 年的原发性通畅率为 69%。
对于伴严重钙化狭窄病变的 PAD 患者，尤其是在生物力学应力较高、支架植入术不可行的部位，斑块旋切术可作为一种替代治疗方法。1 年随访结果显示，Rutherford 评分显著降低，ABI 升高，通畅率合理。
