RESULTS OF DIRECTIONAL PERIPHERAL ATHERECTOMY WITH REFERENCE TO HISTOLOGY, HISTOCHEMISTRY, AND ULTRASTRUCTURE

One hundred patients with symptomatic peripheral vascular disease were treated with a directional atherectomy catheter; 153 lesions comprisi ng 98 stenoses and 55 occlusions were located in the iliac (n = 22), s uperficial femoral (n = 114), popliteal (n = 16), and anterior tibial (n = 1) arteries. The majority of these patients were poor candidates for balloon angioplasty because of the complexity of lesions. There we re 70 eccentric and 28 concentric lesions and 55 occlusions (mean leng th 4.2 +/- 2.9 cm). Acute success rate was 94% for both stenoses and o cclusions. Four patients were treated in both lower extremities. The s tenoses were reduced from 85 +/- 12% to 12 +/- 10% acutely (occlusions 100% to 9 +/- 9%). Six-month angiographic follow-ups were performed i n 81% of treated patients, the others refusing angiography. Mean steno sis after six months was 33 +/- 25% (occlusions 44 +/- 28%). Restenosi s (> 50%) was found in 20% of treated lesions: 26% in concentric lesio ns, 8% in eccentric lesions, and 32% in occluded vessels. Treatment of peripheral vascular disease with the atherectomy device is safe and e ffective therapy with good long-term results. These results were obtai ned in complex lesions with 55 occlusions. Atherectomy seems to be par ticularly beneficial in the treatment of eccentric and complex stenose s and is not limited by occlusion or calcification. Furthermore, insig ht into the pathogenesis of arteriosclerosis and the development of re stenosis is enabled by analysis of removed plaque material.