Stavroulakis Konstantinos, Bisdas Theodosios, Torsello Giovanni, Argyriou Angeliki, Bollenberg Leonie, Schwindt Arne
Clinic of Vascular and Endovascular Surgery, University of Münster, Münster, Germany -
Department of Vascular Surgery, St. Franziskus-Hospital GmbH Münster, Münster, Germany.
J Cardiovasc Surg (Torino). 2019 Apr;60(2):191-197. doi: 10.23736/S0021-9509.19.10843-9. Epub 2019 Jan 18.
Optical coherence tomography (OCT)-guided directional atherectomy enables a real-time visualization of the arterial wall during plaque debulking and might optimize vessel preparation prior to drug-coated balloon (DCB) angioplasty. Nonetheless there is a paucity of data reporting on the outcomes of OCT-guided directional atherectomy with antirestenotic therapy (DAART). Aim of this study was to evaluate the performance of OCT-guided DAART in the treatment of femoropopliteal atherosclerosis.
Patients treated by OCT-guided DAART for femoropopliteal occlusive disease between January 2015 and December 2016 were included into this retrospective, single-center, single-arm analysis. The primary measure outcome of this study was primary patency rate (PPR). Secondary outcomes were technical success rate (TSR), secondary patency rate (SPR) and freedom from target lesion revascularization (TLR).
Thirty-three patients (N.=33, mean age 67±8 years) and 37 lesions were included into this analysis. The median follow-up time was 15 months (interquartile ratio (IQR): 4-21). The majority of patients presented with lifestyle limiting claudication (N.=25, 75%) and de novo atherosclerotic disease (N.=25, 68%). Median lesion length was 70 mm (IQR: 27-104), while 35% (N.=13) of the lesions were chronic total occlusions. Vessel wall calcification was present in 22% (N.=8) of the treated vessels. The mean luminal gain after atherectomy was 52±17% and the median gain after DAART amounted to 68% (IQR: 58-91). The TSR was 95%. The overall 12 months PPR was 93% whereas the SPR and the freedom from TLR at 12 months were 95% and 100% respectively. A single target vessel perforation (N.=1, 3%) and 2 peripheral embolizations (N.=2, 5%) were observed. The bailout stenting rate was 3% (N.=1) and the final angiography did not reveal any flow limiting dissection. An aneurysmatic degeneration of the target vessel was observed in 2 lesions (5%).
In this study, OCT-guided DAART was associated with sufficient luminal gain, low rates of bailout stenting and perioperative adverse events and led to very promising 12-month outcomes.
光学相干断层扫描（OCT）引导下的定向斑块旋切术能够在斑块清除过程中实时可视化动脉壁，并且可能在药物涂层球囊（DCB）血管成形术前优化血管准备。尽管如此，关于OCT引导下联合抗再狭窄治疗的定向斑块旋切术（DAART）的结果报告数据较少。本研究的目的是评估OCT引导下的DAART治疗股腘动脉粥样硬化的效果。
纳入2015年1月至2016年12月期间接受OCT引导下DAART治疗股腘动脉闭塞性疾病的患者进行这项回顾性、单中心、单臂分析。本研究的主要测量结果是原发性通畅率（PPR）。次要结果包括技术成功率（TSR）、继发性通畅率（SPR）和无靶病变血运重建（TLR）。
本分析纳入了33例患者（n = 33，平均年龄67±8岁）和37处病变。中位随访时间为15个月（四分位间距（IQR）：4 - 21）。大多数患者表现为影响生活方式的间歇性跛行（n = 25，75%）和新发动脉粥样硬化疾病（n = 25，68%）。病变中位长度为70 mm（IQR：27 - 104），而35%（n = 13）的病变为慢性完全闭塞。22%（n = 8）的治疗血管存在血管壁钙化。斑块旋切术后平均管腔增益为52±17%，DAART术后中位增益为68%（IQR：58 - 91）。技术成功率为95%。总体12个月的原发性通畅率为93%，而12个月时的继发性通畅率和无TLR率分别为95%和100%。观察到1例（3%）靶血管穿孔和2例（5%）外周栓塞。补救性支架置入率为3%（n = 1），最终血管造影未发现任何限流性夹层。在2处病变（5%）中观察到靶血管瘤样退变。
在本研究中，OCT引导下的DAART具有足够的管腔增益、较低的补救性支架置入率和围手术期不良事件发生率，并带来了非常有前景的12个月治疗结果。
