Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
JACC Cardiovasc Interv. 2017 Feb 27;10(4):403-410. doi: 10.1016/j.jcin.2016.12.014.
This study sought to identify an algorithm for the use of distal embolic protection on the basis of angiographic lesion morphology and vascular anatomy for patients undergoing atherectomy for femoropopliteal lesions.
Atherectomy has been shown to create more embolic debris than angioplasty alone. Distal embolic protection has been shown to be efficacious in capturing macroemboli; however, no consensus exists for the appropriate lesions to use distal embolic protection during atherectomy.
Patients with symptomatic lower extremity peripheral artery disease treated with atherectomy and distal embolic protection were evaluated to identify potential predictors of DE. Plaque collected from the SilverHawk nose cone subset was sent to pathology for analysis to evaluate the accuracy of angiography in assessing plaque morphology.
Significant differences were found in lesion length (142.1 ± 62.98 vs. 56.91 ± 41.04; p = 0.0001), low-density lipoprotein (82.3 ± 40.3 vs. 70.9 ± 23.2; p = 0.0006), vessel runoff (1.18 ± 0.9 vs. 1.8 ± 0.9; p = 0.0001), chronic total occlusion (131 vs. 10; p = 0.001), in-stent restenosis (33 vs. 6; p = 0.0081), and calcified lesions (136 vs. 65; p < 0.001). In simple logistic regression analysis lesion length, reference vessel diameter, chronic total occlusion, runoff vessels, and in-stent restenosis were found to be strongly associated with macroemboli. Angiographic assessment of plaque morphology was accurate. Positive predictive value of 92.31, negative predictive value of 95.35, sensitivity of 92.31, and specificity of 95.35 for calcium; positive predictive value of 95.56, negative predictive value of 100, sensitivity of 100, and specificity of 92.31 for atherosclerotic plaque. Thrombus/in-stent restenosis was correctly predicted.
Chronic total occlusion, in-stent restenosis, thrombotic, calcific lesions >40 mm, and atherosclerotic lesions >140 mm identified by peripheral angiography necessitate concomitant filter use during atherectomy to prevent embolic complications.
本研究旨在基于血管造影病变形态和血管解剖学，为接受股腘动脉血管成形术的患者制定远端栓塞保护装置的使用算法。
血管成形术比单纯血管成形术产生更多的栓塞碎片。远端栓塞保护装置已被证明可有效地捕获大栓子；然而，对于在血管成形术中使用远端栓塞保护装置的适当病变，尚无共识。
对接受血管成形术和远端栓塞保护装置治疗的有症状下肢外周动脉疾病患者进行评估，以确定 DE 的潜在预测因子。从 SilverHawk 鼻锥亚组收集的斑块被送到病理科进行分析，以评估血管造影在评估斑块形态方面的准确性。
发现病变长度（142.1 ± 62.98 与 56.91 ± 41.04；p=0.0001）、低密度脂蛋白（82.3 ± 40.3 与 70.9 ± 23.2；p=0.0006）、血管流出（1.18 ± 0.9 与 1.8 ± 0.9；p=0.0001）、慢性完全闭塞（131 与 10；p=0.001）、支架内再狭窄（33 与 6；p=0.0081）和钙化病变（136 与 65；p<0.001）存在显著差异。简单逻辑回归分析显示，病变长度、参考血管直径、慢性完全闭塞、流出血管和支架内再狭窄与大栓子密切相关。斑块形态的血管造影评估是准确的。钙的阳性预测值为 92.31%，阴性预测值为 95.35%，敏感性为 92.31%，特异性为 95.35%；动脉粥样硬化斑块的阳性预测值为 95.56%，阴性预测值为 100%，敏感性为 100%，特异性为 92.31%。血栓/支架内再狭窄得到了正确预测。
外周血管造影显示慢性完全闭塞、支架内再狭窄、血栓、>40mm 的钙化病变和>140mm 的动脉粥样硬化病变需要在血管成形术时同时使用滤器以防止栓塞并发症。
