ROTATIONAL ATHERECTOMY FOR TREATMENT OF OCCLUDED PROSTHETIC GRAFTS

Potentially, percutaneous rotational atherectomy (RA) can be used to o pen occluded prosthetic arterial bypass grafts with less morbidity tha n surgical catheter thrombectomy. However, RA could damage prosthetic grafts or produce significant distal emboli. To investigate this, acut ely thrombosed and chronically occluded prosthetic grafts, harvested f rom dogs, were placed in an ex vivo perfusion system and recanalizatio n was attempted using the TRAC-Wright rotational atherectomy system. U rokinase (UK) was delivered through the RA catheter in one-half of the procedures. Graft surface thrombogenicity and graft mechanical integr ity after successful recanalization were determined and debris release d during recanalization was collected, Results were compared to those from grafts opened by catheter thrombectomy. One hundred percent (22/2 2) of acute prosthetic graft occlusions and 39% (16/41) of chronic pro sthetic graft occlusions were opened using RA, similar to results achi eved using catheter thrombectomy. In addition, surface thrombogenicity after recanalization of acute graft occlusion with RA was lower than that after catheter thrombectomy (P < 0.05) and infusion of UK improve d RA success in chronically occluded grafts (52% vs 25%). Debris gener ated during RA averaged 15-18 mu g, equivalent to debris generated dur ing catheter thrombectomy, and graft mechanical integrity was unaffect ed by recanalization using RA. Thus, rotational atherectomy is a minim ally invasive means of safe and effective prosthetic graft recanalizat ion that produces a less thrombogenic graft than thrombectomy. (C) 199 4 Academic Press,Inc.