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Combining directional atherectomy, DCB may help patients with popliteal artery lesions
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At 18 months, combined therapy of directional atherectomy and a drug-coated balloon was associated with improved outcomes in patients with popliteal artery lesions, according to new findings.
Researchers performed a single-arm, prospective study of 21 patients (mean age, 63 years; 16 men; three patients with critical limb ischemia) with isolated atherosclerotic lesions of the popliteal artery between October 2009 and February 2014. All patients received directional atherectomy (TurboHawk or SilverHawk, Medtronic/Covidien/ev3) followed by a DCB (IN.PACT Admiral/Pacific, Medtronic, or Freeway, Eurocor). All procedures included use of a distal embolic protection device (SpiderFX, Medtronic/Covidien).
According to the researchers, the goal of directional atherectomy was to reduce plaque burden in the target lesion by at least 50% and the goal of the combined therapy was to achieve a reduction of at least 30% in residual stenosis.
The primary outcome was primary patency. Secondary outcomes included technical success, secondary patency, morbidity and mortality. Mean follow-up was 18 months.
Konstantinos Stavroulakis, MD, from the department of vascular and endovascular surgery at University of Münster, and the department of vascular surgery at St. Franziskus-Hospital, Münster, Germany, and colleagues reported that the technical success rate was 90%, and one patient had flow-limiting dissection that was treated with bailout stenting.
The researchers reported no distal embolic events, but noted that one patient had a perforation of the popliteal artery and two had hematomas at the puncture site. There were two cases of restenosis that were treated successfully.
Primary patency was 95% at 12 months and 90% at 18 months, and secondary patency was 100%, according to the results.
There was one death (5%) during follow-up, but no amputations, Stavroulakis and colleagues wrote.
“The combination of [directional atherectomy] and [DCB] may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint,” they wrote.
In a related editorial, Angelo Cioppa, MD, from division of invasive, Clinic Montevergine, Avellino, Italy, and colleagues noted that these results provide “two additional messages for endovascular interventionists: The use of [directional atherectomy] can improve acute results by reducing the risk of flow-limiting dissections and minimizing residual stenosis and the use of DCB, by limiting late loss, can preserve acute results in the long term.
“This study strongly supports the concept that therapy of [directional atherectomy] and DCB angioplasty for popliteal artery lesions had good midterm performance,” Cioppa and colleagues wrote. – by Erik Swain
Disclosure: The researchers and editorial writers report no relevant financial disclosures.
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