Milnerowicz Artur, Milnerowicz Aleksandra, Kuliczkowski Wiktor, Protasiewicz Marcin
1 Department of Vascular, General and Transplantation Surgery, Medical University of Wrocław, Poland.
2 Department and Clinic of Cardiology, Medical University of Wrocław, Poland.
J Endovasc Ther. 2019 Jun;26(3):316-321. doi: 10.1177/1526602819836749. Epub 2019 Mar 25.
To analyze the long-term outcomes of a hybrid treatment method combining rotational atherectomy with drug-coated balloon (DCB) angioplasty in patients with total in-stent occlusion in the iliac and/or infrainguinal arteries.
Between April 2014 and June 2017, 74 consecutive patients (mean age 66.7±9.7 years; 49 men) with total occlusion of a previously implanted stent underwent endovascular recanalization using the Rotarex system and DCB angioplasty. Half (37, 50%) of the patients had critical limb ischemia (CLI), and 30 (41%) of the procedures were performed in emergency. Mean lesion length was 22±15 cm.
Overall procedure success was achieved in 73 (98.6%) patients. Six (8.1%) CLI patients developed distal embolism that responded to thrombolysis. Three (4.1%) dissections did not require treatment, while 1 (1.4%) perforation necessitated stent-graft implantation. In all, 33 (44.6%) patients had an additional stent implanted, mainly due to a suboptimal outcome (n=28) or complications (n=5 including the stent-graft). The restenosis rate assessed by duplex ultrasound at 12 months was 20.5% (15/73); 4 (5.5%) patients underwent target lesion revascularization. Recurrent restenosis was more frequent in patients with Rutherford category 5 ischemia (p=0.005), in emergency procedures (p=0.021), after extensive procedures involving 3 independent vessel segments (p=0.016), and if a complication arose during the procedure (p<0.001). In multivariate analysis, only occurrence of a procedural complication was an independent predictor of recurrent restenosis at 1 year (OR 63.3, 95% CI 5.7 to 701.5).
These findings imply that rotational atherectomy and DCB angioplasty may provide satisfactory outcomes in the treatment of total in-stent occlusion, with a satisfactory recurrent restenosis rate at 12 months.
分析旋磨术联合药物涂层球囊（DCB）血管成形术治疗髂动脉和/或股腘动脉完全支架内闭塞患者的长期疗效。
2014年4月至2017年6月，74例（平均年龄66.7±9.7岁；49例男性）先前植入支架完全闭塞的患者接受了使用Rotarex系统和DCB血管成形术的血管内再通治疗。一半（37例，50%）患者患有严重肢体缺血（CLI），30例（41%）手术为急诊手术。平均病变长度为22±15cm。
73例（98.6%）患者手术成功。6例（8.1%）CLI患者发生远端栓塞，经溶栓治疗有效。3例（4.1%）夹层无需治疗，1例（1.4%）穿孔需要植入支架型人工血管。共有33例（44.6%）患者额外植入了支架，主要原因是效果欠佳（n = 28）或出现并发症（n = 5，包括支架型人工血管）。12个月时经双功超声评估的再狭窄率为20.5%（15/73）；4例（5.5%）患者接受了靶病变血管重建术。Rutherford 5级缺血患者（p = 0.005）、急诊手术患者（p = 0.021）、涉及3个独立血管节段的广泛手术患者（p = 0.016）以及手术过程中出现并发症的患者（p < 0.001）复发再狭窄更为常见。多因素分析显示，仅手术并发症的发生是1年时复发再狭窄的独立预测因素（OR 63.3，95% CI 5.7至701.5）。
这些结果表明，旋磨术和DCB血管成形术在治疗完全支架内闭塞方面可能提供满意的疗效，12个月时复发再狭窄率令人满意。
