Single Center Experience with Optical Coherence Tomography-Guided Directional Atherectomy System for Below-the-Knee Critical Limb Ischemia.
1Sehrish Memon MD, 2Ramy Sedhom MD, 1Sean Janzer MD, and 1Jon C George MD
1Division of Cardiovascular Disease, Einstein Medical Center, Philadelphia, PA
2Division of Internal Medicine, Einstein Medical Center, Philadelphia, PA
Below the Knee (BTK) peripheral arterial disease (PAD) more often presents as critical limb ischemia. Endovascular revascularization strategies continue to evolve to achieve long-term limb salvage outcomes. Single center experience with optical coherence tomography guided atherectomy using Pantheris SV is reported.
All patients with PAD in femoropopliteal or infrapopliteal vessels (n= 27) who underwent plaque debulking by Pantheris SV were analyzed retrospectively. Baseline comorbidities, Rutherford classification, lesion length and characteristics, adjunctive treatment strategy, device related failures/complications and major adverse events were analyzed. Additionally, 6-month target lesion revascularization (TLR) rate was available for 21 of 27 patients.
Mean age was 70.5, 16 (59%) female, and 19 (70%) with Rutherford Class IV to VI symptoms. Total 58 vessels were treated; 32 ilio-femoropopliteal and 26 infrapopliteal. Chronic occlusions were present in 19% of ilio-femoropopliteal treated lesions and 17.2% of infrapopliteal lesions. The most commonly treated BTK lesions (12 of 26) was anterior tibial artery (ATA). Following atherectomy, 21 were treated with angioplasty, four with angioplasty followed by coronary drug eluting stent (DES), and one requiring cutting balloon and laser atherectomy. Four failures/complications occurred, three device related: failure to pass through lesion due to proximal ATA angulation, coronary DES dislodgement while treating BTK ISR, and one requiring laser atherectomy for no flow post atherectomy and angioplasty. At six months, 2 of 21 (9.5%) patients required revascularization interventions.
Treatment of BTK PAD with imaging guided Pantheris SV atherectomy device appears to be safe with low rate of TLR at 6 months. Future multicenter, randomized trials are needed to confirm these findings.