Wang Hui, Wu Sensen, Meng Wenzhuo, Pan Dikang, Ning Yachan, Guo Jianming, Guo Lianrui, Gu Yongquan
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, 100053, China.
J Cardiothorac Surg. 2024 Dec 19;19(1):653. doi: 10.1186/s13019-024-03164-1.
This study aimed to analyze the safety and mid-term outcomes of a hybrid treatment method combining rotational atherectomy (RA) with drug-coated balloon (DCB) angioplasty in patients with femoropopliteal artery in-stent restenosis (ISR).
This single-center retrospective study enrolled patients from January 2018 to March 2022 who had femoropopliteal artery in-stent restenosis treated by RA and DCB. Preoperative demographics, operative details, and postoperative 12-month follow-up outcomes were analyzed statistically.
38 consecutive patients (31 men; mean age 69.55 ± 9.18 years, range 54-91 years) with Tosaka II (n = 8) and III (n = 30) ISR were treated with RA Most patients had a high prevalence of typical vascular comorbidities. Overall, 50% of patients had chronic limb-threatening ischemia, and the average lesion length was 155.0 ± 54.8 mm. The primary patency rate, assessed by duplex ultrasound at 12 months, was 86.7%; 7.9% (3/38) of patients underwent target lesion revascularization (TLR). The overall mortality rate was 2.6% (1/38), and the ulcer healing rate reached 83.3% (5/6), with none of these patients requiring amputation. Subgroup analysis based on target lesion length (≥ 200 mm) showed that the 12-month primary patency rate was 75.0% for the ≥ 200 mm group and 95.5% for the < 200 mm group. Cox univariate regression analysis did not identify any risk factors affecting primary patency rate and freedom from clinically driven TLR (CD-TLR) at 12 months.
RotarexS combined with DCB seems safe and provides acceptable 12-month primary patency and TLR rates in femoropopliteal in-stent restenosis. Well-designed comparative or large registry studies are necessary to provide high quality and long-term data on this technique to provide firm conclusions on the efficacy of RotarexS and DCB in ISR in the femoropopliteal area.
本研究旨在分析旋磨术（RA）联合药物涂层球囊（DCB）血管成形术治疗股腘动脉支架内再狭窄（ISR）患者的安全性和中期疗效。
本单中心回顾性研究纳入了2018年1月至2022年3月期间接受RA和DCB治疗的股腘动脉支架内再狭窄患者。对术前人口统计学资料、手术细节及术后12个月的随访结果进行统计学分析。
连续38例患者（31例男性；平均年龄69.55±9.18岁，范围54 - 91岁），Tosaka II型（n = 8）和III型（n = 30）ISR患者接受了RA治疗。大多数患者典型血管合并症的患病率较高。总体而言，50%的患者患有慢性肢体威胁性缺血，平均病变长度为155.0±54.8mm。12个月时通过双功超声评估的主要通畅率为86.7%；7.9%（3/38）的患者接受了靶病变血运重建（TLR）。总死亡率为2.6%（1/38），溃疡愈合率达到83.3%（5/6），这些患者均无需截肢。基于靶病变长度（≥200mm）的亚组分析显示，≥200mm组12个月的主要通畅率为75.0%，<200mm组为95.5%。Cox单因素回归分析未发现影响12个月主要通畅率和免于临床驱动的TLR（CD-TLR）的任何危险因素。
RotarexS联合DCB似乎是安全的，在股腘动脉支架内再狭窄中提供了可接受的12个月主要通畅率和TLR率。需要设计良好的比较研究或大型注册研究来提供关于该技术的高质量长期数据，以便就RotarexS和DCB在股腘动脉区域ISR中的疗效得出确凿结论。
