Foley T Raymond, Cotter Ryan P, Kokkinidis Damianos G, Nguyen Daniel D, Waldo Stephen W, Armstrong Ehrin J
Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Catheter Cardiovasc Interv. 2017 May;89(6):1078-1085. doi: 10.1002/ccd.26984. Epub 2017 Mar 15.
To assess the intraprocedural and mid-term outcomes of orbital atherectomy (OA) combined with drug-coated balloon (DCB) angioplasty for the treatment of calcified femoropopliteal disease.
In this single-center cohort, 89 patients (139 lesions) were treated with DCB angioplasty for claudication or critical limb ischemia (CLI). Angiographic characteristics and procedural outcomes were reviewed for patients treated with or without adjunctive OA. Lesion calcification was graded using two previously published scoring systems, the angiographic calcium score (ACS) and the peripheral artery calcification scoring system (PACSS).
Among 139 lesions, 40 (29%) were treated with OA + DCB. Mean lesion length was 135 ± 100 mm for lesions treated with OA + DCB and 139 ± 100 mm for DCB alone (P = 0.9). Moderate to severe calcification was present in 83% of patients treated with OA, compared to 42% of patients treated with DCB alone (P < 0.001). Lesions treated with OA + DCB were less likely to require bailout stenting (18% vs. 39%, P =0.01). Rates of embolization (0% in OA + DCB vs. 2% in DCB only, P = 0.4), dissection (13% vs. 14%, P = 0.8), and perforation (0%) did not differ significantly between groups. The freedom from TLR at 1 year was 82% in both groups (P = 0.6) while primary patency was 81% in-patients treated with DCB alone and 77% in-patients treated with DCB with concomitant OA (P = 0.8).
In this single-center analysis of patients undergoing DCB angioplasty for claudication or CLI, OA was most often used for the treatment of severely calcified lesions. These lesions were more likely to be treated with scoring balloons and less likely to require bailout stenting. At 1 year, target lesion revascularization and primary patency was similar in patients treated with and without adjunctive OA, despite the higher lesion complexity among those receiving the combination procedure. © 2017 Wiley Periodicals, Inc.
评估眼眶斑块旋切术（OA）联合药物涂层球囊（DCB）血管成形术治疗钙化性股腘动脉疾病的术中及中期疗效。
在这个单中心队列研究中，89例患者（139处病变）因间歇性跛行或严重肢体缺血（CLI）接受了DCB血管成形术治疗。对接受或未接受辅助OA治疗的患者的血管造影特征和手术结果进行了回顾。使用两种先前发表的评分系统对病变钙化进行分级，即血管造影钙评分（ACS）和外周动脉钙化评分系统（PACSS）。
在139处病变中，40处（29%）接受了OA + DCB治疗。接受OA + DCB治疗的病变平均长度为135±100mm，单纯DCB治疗的病变平均长度为139±100mm（P = 0.9）。接受OA治疗的患者中83%存在中度至重度钙化，而单纯接受DCB治疗的患者中这一比例为42%（P < 0.001）。接受OA + DCB治疗的病变需要补救性支架置入的可能性较小（18%对39%，P = 0.01）。两组间栓塞率（OA + DCB组为0%，单纯DCB组为2%，P = 0.4）、夹层形成率（13%对14%，P = 0.8）和穿孔率（0%）无显著差异。两组1年时无靶病变血管重建率均为82%（P = 0.6），单纯DCB治疗患者的一期通畅率为81%，DCB联合OA治疗患者的一期通畅率为77%（P = 0.8）。
在这个对因间歇性跛行或CLI接受DCB血管成形术的患者进行的单中心分析中，OA最常用于治疗严重钙化病变。这些病变更可能使用评分球囊进行治疗，且需要补救性支架置入的可能性较小。1年时，接受辅助OA治疗和未接受辅助OA治疗的患者的靶病变血管重建和一期通畅情况相似，尽管接受联合手术患者病变的复杂性更高。© 2017威利期刊公司。
