PERCUTANEOUS PERIPHERAL ATHERECTOMY USING THE ROTABLATOR - A SINGLE-CENTER EXPERIENCE

Purpose: In order to assess the role of percutaneous peripheral rotati onal ablation using Rotablator(TM), 150 symptomatic patients (94 males , 56 females; mean age 73 +/- 1 years, range 42 to 90) having 212 comp lex peripheral vascular lesions were treated. Methods: Fifty percent o f lesions were below the knee; 65% of patients had severe claudication , 11% moderate (24% were in stage III or IV Fontaine classification). The femoral lesions were significantly longer than those at other site s (5.7 +/- 0.4 versus 2.9 +/- 0.3 cm, p < 0.001). The mean length was 4.0 +/- 0.2 cm (range 1 to 20). All the lesions were considered comple x; 93% of the lesions were calcified, and 63% were located at a bifurc ation. Complementary balloon dilation (percutaneous transluminal angio plasty [PTA]) was significantly (p < 0.001) more frequent in femoropop liteal lesions (70 PTAs in 86 femoral arteries, 10 PTAs in 19 poplitea l arteries) than in distal leg lesions (14 in 106 arteries). Results: After Rotablator therapy alone, the percent stenosis decreased from 81 .0% +/- 0.8% to 18.0% +/- 1.1%. The residual stenosis was greater at t he femoral (44%) than at the distal level (19%) (p < 0.01). Adjunctive PTA (47 lesions) lowered residual stenosis to 10% at the femoral leve l and 3% at the distal level. Thirty-seven intraprocedural complicatio ns occurred (spasm, thrombosis, dissection, perforation, distal emboli , no reflow); seven procedures subsequently failed for an overall tech nical success of 97%. The mean follow-up period was 14.4 +/- 1.0 month s (range 1 to 51). Among 125 patients having a follow-up period greate r than or equal to 4 months, 114 patients representing 163 lesions und erwent angiography. One hundred twenty-three lesions (76%) were patent , and 40 lesions (24%) showed restenosis (greater than or equal to 50% luminal narrowing) of 82.0% +/- 2.1%. The restenosis rate was higher in femoral (36%) than in distal (21%) or popliteal arteries (7%). Rest enosis was more frequent for all lesions greater than or equal to 7 cm (p < 0.001) and for both above- and below-knee locations: 55% versus 19% for < 7 cm at the femoropopliteal level (p < 0.03), and 80% versus 18% at the distal level (p < 0.01). Conclusions: In our experience, p ercutaneous peripheral rotational ablation has taken a pre-eminent pos ition in the treatment of distal leg arteries, especially in complex l esions. Our results have led us to broaden its indications to complex vascular lesions less than or equal to 6 cm. In particular, the use of this technique for treatment of runoff vessels should improve the lon gterm patency of proximal PTA and bypass grafts. This device has becom e indispensable in our laboratory, where Rotablator therapy comprises 15% of all PTA procedures.