Treatment of chronic occlusions of the iliac or femoropopliteal arteries with mechanical rotational catheters.

PURPOSE

The main problem with treating chronic lesions with percutaneous transluminal angioplasty (PTA) or stent implantation is the relatively high restenosis rate. The objective of this prospective single-center study was to evaluate a mechanical rotational catheter (Straub Rotarex®) for its safety and efficacy in the treatment of chronic vascular occlusions.

MATERIALS AND METHODS

There were 40 patients with a mean age of 67.3 ± 7.6 years (51 - 86) treated by means of the Rotarex® catheter. All patients had chronic occlusions (> 6 months) of the iliac (n = 4) or femoropopliteal arteries (n = 36). The preinterventional Rutherford stage was on average 3.15 (2 - 5). The mean lesion length was 12.3 cm (2 - 24 cm). The ankle-brachial index (ABI) was determined prior to and after the intervention, as well as after 12 months. An additional follow-up was performed using color-coded duplex sonography.

RESULTS

The technical success rate was 100 %. In 27 patients (67.5 %), adjunctive balloon dilation was performed, and 7 (17.5 %) patients required a stent implantation. Clinically, there was an increase in the ankle-brachial index from 0.57 ± 0.15 to 0.82 ± 0.16 post-interventionally. After 12 months, it was 0.80 ± 0.12, and the average Rutherford stage fell to 1.65 (1 - 3). During the follow-up observation period, there were 9 (22.5 %) restenoses. Two dissections after balloon dilatation were recorded as peri-interventional complications. No distal embolizations were observed. There were no amputations or deaths during the entire period of the study.

CONCLUSION

The atherectomy of lesions of the iliac and femoropopliteal arteries using the Rotarex® system is safe and effective. The low rate of peri-interventional stenting and the low rate of restenosis at 12 months appear to be promising.